Another possible surprise bill question

So my toddler busted his lip over the weekend, I took him to a PM Pediatrics (which is in network with my insurance company) just to double check to see if he needed stitches, as I was trying to avoid the ER if possible. The doctor at PM peds said he did need stitches, and called in a plastic surgeon that they work with, and he got stitched up. I found out that this plastic surgeon is not in network. I called the plastic surgeon's office yesterday because the dr said to make a follow up appt later this week in his office, which they said there was no charge for because they bill for just the date they stitched him, but that they want me to fill out paperwork, and one of which is a permission form allowing them to fight with the insurance company for payment, so I don't have as big of an out of pocket cost. I guess my question is, if all this goes down and they end up billing me whatever they could not get from the insurance, am I still able to file this as a surprise bill? Has anyone went through a situation like this before? DH is pissed at me for not just going to the ER to begin with.

Re: Another possible surprise bill question

What is a surprise bill? I have never heard of that....

The plastic surgeons that I have used in the past only took what the insurance company gave them even though their fee would have been more. They did not bill me for the additional.

If you took him to the ER they would have also suggested that they call in a plastic surgeon so you can tell your DH that it would have been the same either way. Whenever you are dealing with a kids face the ER docs around here do not want to touch it and believe me, you don't want them to. My daughter needed stiches in Ocean City, MD and there were no plastic surgeons even remotely close. She still has a scar ten years later and will for life.

Another possible surprise bill question

I’ve had this with anesthesiologists that my doctors used that weren’t in network. One bill was for 9k about 5 years ago for arm surgery and the other was to the tune of almost 16k last year for back injections. After the ins co billed , the dr office sent me an appeal form to sign that they had filled out on my behalf, I sent it back and that was the end of it. Never heard from anyone again. I don’t remember all the ppwk I filled out for the arm surgery but for my back was a from to sign for them to fight on my behalf,when the final bill came in, which they did.

Another possible surprise bill question

Since it was at the same time as the visit - you shouldn’t be responsible and Insurance should cover the doctors fees from the initial visit. I had an issue with my sons ER visit a few mos ago. Insurance denied it incorrectly.

Re: Another possible surprise bill question

Re: Another possible surprise bill question

Yes. I slipped on ice, cracked my eyebrow open pretty bad. Went to urgent care, they referred me to a plastic surgeon since it was bisecting my eyebrow and they were worried my eyebrow would look off if it wasn't done just right.
The surgeon they referred me to met me at a hospital ER he was affiliated with. The ER was in network...he was not.
However he took all my insurance info and assured me he would take whatever my plan paid him.
And he clearly did because i never received a bill from his office but I did receive a statement of benefits from my insurance and what he billed for the 20 minutes it took to stitch me was insanity. But that was the last I heard, thankfully
A lot of times they will just take what your insurance pays and thats it

Re: Another possible surprise bill question

Re: Another possible surprise bill question

Re: Another possible surprise bill question

I was in a similar situation a few years ago. Went to an urgent care , they called an ortho surgeon in and they were out of network. Insurance refused to pay because it didn't fit their "emergency" requirements. They said if it was a real emergency, I should have gone to the ER. I wasn't successful fighting it.

Hopefully your insurance will cover it. After what I went through, I always go to the ER if it's questionable. I only go to urgent care if it's something I would go to my primary Dr for, but just don't want to wait for an appointment. For example, when I get a sinus infection or something and my primary has a 4 day wait.

Re: Another possible surprise bill question