My son had tubes put in and adenoids taken out. BFD. It is his third set of tubes. Fairly routine at this point.
We were pre-certified by our insurance, through the hospital. "You will have to pay about $1000." Fine, whatever.
He goes and gets it done. We get the EOB today.
The MOTHER%^&$#@$%@# anesthesiologist is out of network. (The hospital and the surgeon on in network, but not the anesthesiologist.)
As a refresher for those who have not looked at their insurance schedule lately, here is how it works, more or less:
In Network: Insuance company has a contact with the hosipital. Billing code X is paid Y. This is regardless of whatever the hospital has on their "price list." It already has been prenegotiated.
Out of network: Hospital charges whatever is on their pricelist and sends it to the insurance company. The insurance compay ignores what the charge is and pays X% of what their resonable and customary table tells them it should be. You (the insured) are liable for the remainder.
$1300 for the anesthesiologist for five minutes of anesthesia that required no needles. OVER AND ABOVE WHAT THE INSURENACE PAID!!!! (Don't get me wrong, I understand that the anesthesiologist is, and needs to be, expensive. The liability potential is huge and the skill needed is quite high.)
This is the $%^&$% hospital playing fast and loose. While I have no direct knowledge to their operating procedure, I would bet my next paycheck that the anesthesiologist not being in network is completely intentional and desigened to enhance the bottom line.
Instead of that steaming pile horse **** they call health care reform (takeover) this is the kind of **** that needs to be reformed.
I am furious!!!!!!!