I live in Illinois and have BCBS bronze PPO for insurance. A few months back, I had to have a C-section because my baby was small for gestational age and breech. This was scheduled one week in advance. MY OBGYN walked me through how the procedure would be done, she never told me that an additional doctor and surgeon would be present though (which plays into it later). At the beginning of the week of my surgery, I received a call from a BCBS representative telling me that "everything had been pre-approved and would be covered." Wednesday night I called the hospital to ask if I could drink water. I later got a call back from the nurse in the delivery ward that I had spoken with telling me she didn't see me on the schedule for a c-section the next morning (not sure if this plays into scheduled doctors or not). They sorted that out apparently. Next morning I go and check in and of course I was required to sign the waiver that says they can bring in out of network doctors if needed. I assumed this was if an emergency took place and I started dying on the operating table, sure bring in the Pope to save me if you need to. At this point though, I specifically asked if everything was going to still be covered by my insurance and was reassured that it was (in-network hospital, in-network doctor, in-network surgeon, in-network anesthesiologist etc.). They asked me to pay up to the remaining part of my deductible at that point, which I did (about $2,500). Once I am checked in, my OBGYN comes in and does a last minute ultrasound to make sure baby hasn't turned (she hadn't), two anesthesiologists come in and introduce themselves as well as a few nurses. At no point did another doctor or surgeon come in. I get wheeled in and after I get my epidural a big blue drape goes up so I can't really tell how many extra people kept streaming into the operating room at that point. All goes well thankfully.
About a month later the bills start coming in. Most are paid off in full or we owe a small amount, which was expected. One of them is for my OBGYN for about $5000 for "obstetric care" which is fully covered. The other is for an out of network OBGYN that was unknowingly part of my surgery for the same thing, $5000 for "obstetric care." For this one 0% is being covered by insurance. I contact BCBS and ask why, they tell me it is an out of network doctor who is billing globally. They tell me to contact the hospital to sort it out. Contact the hospital, they tell me they can't do anything and either BCBS or Mercy (the hospital the other doctor was from) need to sort it out. Contact Mercy and they tell me the hospital and BCBS need to sort it out. So a few runarounds later someone at BCBS tells me that when I was told I was pre-approved and everything was covered, that meant for the hospital stay - not the doctors for a major scheduled surgery. They told me it was my responsibility to ask. This is the first time I've had major surgery, but when someone calls and tells me everything is pre-approved and covered by insurance, I stupidly thought that included the doctors. The representative did not specify it was only for the hospital stay at the time either. At no point was I told that an out or network doctor was going to be a part of my surgery, and because of that phone call, I didn't think I needed to further ask. We have tried to appeal, and the claim has been denied. A patient advocate from Mercy just contacted me yesterday and told me to write up an email detailing what happened so he could try to appeal to BCBS on my behalf.
My husband and I were very responsible and made sure we had our deductible fully put aside in savings and enough to cover small bills along the way, but we really cannot deal financially with a random $5,000 bill. Is there anything else I can do? I feel like I really got blindsided by this because a BCBS representative called me to tell me everything was approved and covered, but then it wasn't. I was also told at the hospital that everything was going to be covered by my insurance because it had been pre-approved. I understand I signed a waiver right before my surgery to bring in outside doctors if needed, but I also didn't think they would schedule an outside doctor and not even mention it to me - I assumed this was for emergency situations. Any help would be wonderful, and sorry if this is the wrong place or if I left out any useful information.
Submitted October 18, 2017 at 06:33AM by Zoeyxoxo http://ift.tt/2ys8ucJ
