Son broke his wrist during a football game .. went to an ER this IS a provider. Now, almost 4 weeks later, we get our EOB and little to nothing was paid for and nothing discounted for the ER docs themselves. (Hospital bill has yet to come). Our deductible of $5600 has indeed been met and we're in the 20% coinsurance window.

It seems that the trend is that ER docs are NOT hospital based (90% I'm told of ER docs are NOT providers for MOST insurances). What the hell???

Now we get to wait and see what the Shcumacher group and the Physician group decides whether or not to give us a BCBS negotiated rate as we DID INDEED go to a BCBS provider hospital.

This sucks. Not that we can't pay it should they "decide" to not discount anything BUT 1) how in the hell are you supposed to know that the ER docs aren't providers and 2) what choice do you REALLY have when it's an emergency???

Again, it just sucks. We're at their mercy.

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Posted by Layabout

Baton Rouge

Member since Jul 2011

11082 posts

Posted on 11/25/13 at 11:22 am to tiger91

I've had similar problems with pathology labs and anesthesiologists.

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Posted by tiger91

In my own little world

Member since Nov 2005

36706 posts

Posted on 11/25/13 at 11:36 am to Layabout

Do you remember how it worked out? I'm talking to the tune of about $1200 here if they don't discount it. Again we can pay it but it's the principle.

A provider FACILITY should have a PROVIDER staff.

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Posted by Layabout

Baton Rouge

Member since Jul 2011

11082 posts

Posted on 11/25/13 at 11:53 am to tiger91

They were out-of-network so I was stuck with it. I think the insurance only paid 70% instead of the full amount. I was mightily pissed off that the surgeon and the hospital didn't let me know in advance that they were using out-of-network providers. They must have had some other unhappy customers previously.

This post was edited on 11/25/13 at 11:55 am

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Posted by lsujunior58

Member since Oct 2011

82 posts

Posted on 11/26/13 at 4:16 pm to Layabout

quote:
I was mightily pissed off that the surgeon and the hospital didn't let me know in advance that they were using out-of-network providers. They must have had some other unhappy customers previously.

This always sucks, but the subscriber (you) receives a summary plan doc at the beginning of every plan year that explains the facility vs. physician charges. Provider websites always (required by law) have a list of both network physicians AND facilities. It is always good to look at the beginning of each plan year at this list to know where to go if something happens.

70% also isn't bad... 80% of physician/facility charges is the average. If you're truly getting billed for out-of-network on a typical plan, you'll be paying 40-50% of the costs.

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Posted by tiger91

In my own little world

Member since Nov 2005

36706 posts

Posted on 11/26/13 at 6:26 pm to lsujunior58

lsujunior58, you are right ... it is the subscriber's responsibility say in the event of scheduled/planned surgery (husband had a hernia repair in January -- I made SURE to ask about providers).

HOWVER, in emergency situation, I'm not ABOUT to take the time to look it up ... that's just wrong. And I thought maybe I COULD have driven the extra 30 minutes to Lafayette BUT those ERs don't use inhouse docs for the ER either.

It's just going to be WRONG if they don't give us the discounted rate ... we owe 20% of the contracted rate and that's ALL I should have to pay (as our ded has been met).

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