You know, when V Chip posted this back in March I chuckled because I thought "no way".
As most of you know, I tore my achilles tendon in March. Had surgery in April to repair. One of my factors in opting for surgery was the out of pocket costs i would incur having the surgery.
So I called my healthcare provider to find out exactly what my policy would cover. I had a $2000 deductible and then 50% co pay for "outpatient surgery" IN NETWORK. My Orthopedic surgeon was "in network". So on 3 separate occasions, my wife ( who takes wonderful notes when speaking to folks in cases like this ) and my self both spoke with the Surgeons asst. who handles the scheduling to get a pretty good idea of what the surgery will ultimately cost so we can determine what WE would pay for.
Surgeon cost - $2528 ( spot on)
Anesthesia - $1200 ( pretty close - $1340 )
Outpatient room charge ( at facility ) - $3000 ( This is where it comes off the rails )
So based on what my health insurance would pay, i would be out of pocket about $4000. Manageable. So we scheduled the surgery. I arrived at the facility at 6:30, filled out ppwk, gave them my health insurance card and waited approx 30 min to be called back. Just before being called back my wife was asked to pay $3042.70. We figured they already calculated what we would owe based on my health insurance. I was prepped for approx 45 min, Surgery took all of 32 min and i spent another 90 or so min in recovery. I was released to go home before noon.
Last night I received a "summary of account" by my healthcare provider. It shows that the Outpatient Facility was OUT OF NETWORK. Therefore, they are not paying them a dime. Furthermore, the Facility charged my healthcare provider $12,171. Thats right. $12,171. That is a looong way off from the $3000 we were told back in March on 3 separate occasions. I called my provider and they explained all of this. They also explained that under my "deductible" there was a $2006.63 charge....this charge is what THEY determined to be a FAIR charge for the facility based on MEDICARE standards. But because this Facility was OUT OF NETWORK for ME, they can basically charge WHATEVER they feel like charging me and I AM GOING TO BE RESPONSIBLE for this.
I plan on making some calls this am. First to my surgeon then to this Facility. I have no problem paying $3-4000 for the service. I have already paid them $3042. I just dont see how this is even legal.
I want to know how my surgeon can be IN NETWORK, yet perform his surgery at a place that is OUT OF NETWORK when his office AND the facility both had my health insurance info and yet never ONCE advise me that the Facility is going to be considered OUT OF NETWORK AND NOT COVERED.
Im so effn mad that im past mad ( if that makes sense ) im rather calm since I realize any yelling, screaming and/or cursing will get me nowhere fast.