How is this fair? (Insurance costs for NICU)

The participating Dr. at the NICU where DD was admitted was "out of network" and now we are responsible for out of network costs ($1000!!)

Don't get me wrong I am grateful we have insurance but the girl put it to me like "If you used someone in network we would have covered it 100%"

I explained to her that it was the NICU and that was really the furthest thing from my mind..

Did anyone ever have this? Can I fight it?

Re: How is this fair? (Insurance costs for NICU)

DS's stay in the NICU cost $46,000

we are responsible for about 3,000 for JUST HIS STAY

in total we have about 5,000 worth of debt from DS's stay in the NICU

all i can say is go through EVERY SINGLE BILL b/c DH did & we found $1300 worth of bills that were a mistake! call your ins company & fight what you can!!

Re: How is this fair? (Insurance costs for NICU)

such ********!!!

Re: How is this fair? (Insurance costs for NICU)

DD was in the NICU and I got OUTRAGEOUS bills after too b/c some of the doctors that were on call were out of network. I called Aetna, they looked into it and yes they did adjust the charges.... Hope the same for you!

Re: How is this fair? (Insurance costs for NICU)

Ugh we are going threw this from when I delivered dd, The insurance is saying that the anastlogist and the assting doctor are out of network so now I owe them something like 5grand! I said that's insane I have no choice who gives me anastia and who sits in on the surgery! uhh we are fighting it, write a letter to ur insurance stating that you had NO CHOICE in the doctors,.

Re: How is this fair? (Insurance costs for NICU)

It is ridiculous because you cant choose, but be happy you have this! Imagine what your total bill was!! We had to pay. About that much too for NICU too, i think it was hospital deductable though.

Re: How is this fair? (Insurance costs for NICU)

Posted by septmonkey

DD was in the NICU and I got OUTRAGEOUS bills after too b/c some of the doctors that were on call were out of network. I called Aetna, they looked into it and yes they did adjust the charges.... Hope the same for you!

Re: How is this fair? (Insurance costs for NICU)

I would try to see if the insurance co/hospital would be willing to work with you to adjust the charges.

Re: How is this fair? (Insurance costs for NICU)

Thanks- I am going to call back when I get the bill. We just got the Explanation of Benefits today.

Re: How is this fair? (Insurance costs for NICU)

Re: How is this fair? (Insurance costs for NICU)

We had the same thing happen to us. We were responsible for some of the charges unfortunately , but most were at least reduced.

I argued with everyone but they said it was my responsibility to ensure that the doctors were in my network. Yes, in the midst of going into labor prematurely and having my baby rushed off to the NICU, that was the first thing on my mind . I never got it though, why do they take all my insurance info 5 billion times if they have doctors that work there that don't accept that insurance . I don't know enough about this stuff I guess.

Message edited 1/6/2011 8:38:00 PM.

Re: How is this fair? (Insurance costs for NICU)

Same thing happened w/ us--I got a bill for like $30,000 for DS's NICU stay. I fought it (Empire) and won and paid $0!!!! Fight it!

Re: How is this fair? (Insurance costs for NICU)

I would wait for the actual bill and I would totally fight it!!! good luck!

Re: How is this fair? (Insurance costs for NICU)

You have to contact your insurance company and let them know that you didn't get any say in who the doctor was. You need to remind them that your policy most likely has a provision that as long as the care was at a participating hospital that all doctors are covered. I had this happen with my surgery - it was not an elective surgery and I was not given a chance to pick the surgeon who turns out was not participating. A few phone calls to the insurance company (supervisors were more helpful) and they paid him. Don't give up! Good luck.

Re: How is this fair? (Insurance costs for NICU)

I still have a 3000.00 bill from Sophia's stay in the NICU last July. The only reason she went to the NICU was bc she weighed 4 lbs 2 oz there was nothing else wrong with her. A non GHI doctor saw her and now I have been fighting them bc I dont think it fiar I have to pay this bill. I called GHI and they said they couldnt do anything and the hospital said the same thing and put me on a payment plan and I am in no rush to pay them off since the Dr that saw her isnt even willing to reduce her rates at all.

Re: How is this fair? (Insurance costs for NICU)

I would immediately file a written appeal. Talking to them on the phone isn't going to do anything. If the first appeal is denied, submit a second, and file a complaint with the NYS dept of insurance. Most people don't have the energy to write a letter and deal with it, so they just give in and pay and that is what the insurance companies expects you will do.

Re: How is this fair? (Insurance costs for NICU)

Check with your Benefits dept. If the hospital is 'in network', then all doctors in that hospital are covered as 'in network'. Same thing happened to me when I had my C-section.

The Anesthesiologist on call that night was out of network, which of course I didn't know until I received a $4000 bill 4 months later.

I spoke with my Benefits dept...and they said, no way. They just need to code the bill correctly and insurance will pay.

I know everyone's plan is different. Just check with Benefits dept before paying anything.

Good luck!

Re: How is this fair? (Insurance costs for NICU)

Definately fight it! We are still dealing with $8890 worth of a NICU bill just for his incubator for the month of August! Apparantly the hospital billed our insurance twice & of course they already got paid their $48000 for his stay but they want to know where their remaining $8890 is My insurance carrier has been on the phone with them diligently & so far it looks like it will be cleared up!

Re: How is this fair? (Insurance costs for NICU)

I know before I had DD I called Oxford and asked what would happen if one of the anesthesiologists was out of network for my epidural.

They told me that as long as I was at an in-plan facility they would cover everything under the regular hospital copay. I would definitely call - I think that you will get it straightened out.

Re: How is this fair? (Insurance costs for NICU)

We had to pay $750 for dd's NICU stay. Her stay cost $189,000 total. The $750 was our co-pay. I don't think it is fair, and you should fight it.

Re: How is this fair? (Insurance costs for NICU)

Sorry for spelling postingbfrom my phone. I had something similar and appealed and won. Fm me if you want an example of the letter i wrote.

Re: How is this fair? (Insurance costs for NICU)

If your child was admitted as an emergency the insurance company has to pay the doctor in full...or at least that is my understanding.

I would definitely give your insurance company a call....

Re: How is this fair? (Insurance costs for NICU)

Fight it!
I am paying off my twins NICU bills still and they are 14 months old! I am down to $500ish dollars for each of them.

But the original bills they sent were outrageous. I had an itemized bill sent and fought some things and got it lowered. Don't go down without a fight!!! LOL

Re: How is this fair? (Insurance costs for NICU)

I would definitely fight it! It was an emergency situation and you couldn't control every single person who comes in contact with you or your child. As long as the hospital you were in was a participating hospital they should be shelling out the money for whatever NICU doctor was talking care of your kid.

I was in a similar situation a few years ago: had a minor surgery in LIJ and got a bill for the anestheseologist who I was told was out of network. I called my insurance and explained that as I was lying half nakked on the surgical table I couldn't possibly have been asking every single person who touched me if they were in fact, a participating provider. They ended up covering the cost.

Definitely don't give up without a major fight. Best of luck!

Message edited 1/6/2011 11:30:21 PM.

Re: How is this fair? (Insurance costs for NICU)

If the hospital you delivered at was in network, they should cover any of the doctors who treated your DC in the NICU. These are emergency type of situations and it is covered.

Call your insurance company for sure.

DS's NICU stay cost $270,000. Insurance paid for it all (although their negotiated rates allowed them to pay something like $66,000 or so).