Expert: Tricia - 10/16/2006

Question
I had to have an emergency C-Section in June. My OB performed the operation and I have already received all the bills from the hospital/doctor/etc. Today I got an explanation of benefits from my insurance carrier that was in relation to a claim from another doctor that I did not recognize; I called and they advised me that this was the "assistant" to my C-Section. Apparantly, this doctor does not take my insurance - I was at a hospital that takes my insurance and taken care of my OB who does take my insurance (I chose this doctor and hospital for that reason)shouldn't I have been told upfront that this "assitant" did not take my insurance and would be sending me a bill for $2,000.00 - can I fight this?

Answer
Hi Amy!

Yes you should have been advised.......since you did your job to ensure your Doctor and the hospital were in the network and you were not even aware of this so called
Assistant, then it is not fair for you to be liable.  

I would call this Doctor and advised that you were very careful of staying in the network and the hospital and your Doctor were both well aware of this issue and since you did not even know him/her then it is not fair to make you liable.  Tell them there would be no way that you would approve any Dr not in the network to assist in any operation.  Tell them also you feel this sounds illegal and you may have to report them to the Insurance commissioner and perhaps maybe the local news station.  Even if you don't say you will........sometimes this will scare them to waive your bill.  Alot of people would probably pay them so I am sure they can afford for a few not to.

The trick is to stand your ground and continue to refuse to pay them on the grounds of something smelling "fishy".......

The more you fight them and don't give up, the better chance you will have for them to waive your charge.  Tell them whatever you have to.....a little lie here or there may help.

Good Luck!
Tricia