re: Here is an interesting story, maybe some lawyer advice might help

If it was an emergency service, wouldn't any expenses incurred for the emergency be covered as if it were "in-network" until the patient is secure and the services are deemed to no longer be considered an emergency?

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Yeah for all the faults that other healthcare systems have, this is something they have figured out. "Out of network" billing shouldn't exist. The fact that you can go to a hospital in network, have a surgeon in network, have a surgery covered by insurance, but the guy who handed the anesthesiologist the potassium to paralyze you was out of network, so you'll be paying that $5000 out of pocket, is ridiculous

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I agree. This has happened to us a few times, and it's usually the anesthesiologist that's out of network. I just simply tell them to figure it out on their end b/c i'm not paying it, and we've never had to pay it.

It's one thing if you have some random insurance and things are out of network, but when you have Blue Cross, nothing should be out of network. Blue Cross covers 2/3's of the state of LA. Only AL, also Blue Cross, and KT have a higher percentage of enrollments with one provider.

Might be reaching, but it sounds like it might be the start of a class action against the ambulatory service for fraud. Especially if one of the conditions of them getting the county contract was they would be in-network for BCBS as you described.

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I saw some bullshite the other day where a guy was having surgery. He made sure to check that all the doctors and facilities were in network. After it’s all done he gets a huge bill because some machine they used was loaned from an out of network hospital or something and not covered.

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My wife had a similar occurance where a machine or device used in her procedure was from an out of network facility.

I had the same problem..

Admitted to OLOL-Livingston and had to move to OLOL-Essen.

Acadian was out of network for Aetna and the ride to Essen was $3K out of pocket.

They can send to collections, kid had emergency room visit and they kept him overnight. Got multiple really high bills, and insurance hadn't been applied-and was told to wait to pay. Two months later bills come in really low except 1, paid the smaller ones and figured id get lower for the other. Thought it was over and then started getting calls from what i thought was a spammer - answered phone a few weeks into it and it was collections. Turned out that portion of bill was never sent to insurance.

That's why people say it's all about networking.

No surprises act only applies to air ambulance and does not apply to ground ambulance unfortunately. The act was set up to get the patient out of the middle of out of network billing disputes between the insurance and the provider. It covers emergency services and out of network physician services at an in network hospital/facility.

There are also state protections in certain states depending on what time of health plan you have (self funded ERISA vs. fully funded or state/federal employees).

It works for clinicians covered under the NSA or various state laws on those situations, but not for ground ambulance where it’s still a racket.

My dad was discharged from the hospital to a skilled nursing facility via ambulance. The ambulance company billed Blue Cross $1500 which BC denied as not medically necessary. The company then billed us $250 and wrote off the rest.