Healthcare - out of network expenses
Oct 28th 2019, 6:44 pm
#61
Lost in BE Cyberspace
Joined: Jan 2006
Location: San Francisco
Posts: 12,865
Re: Healthcare - out of network expenses
I've already posted this in another thread
https://www.commonwealthfund.org/blo...alance-billing
scroll down for a map of the states, click on the states to find out current law.
" In Texas, HMO and EPO members must be held harmless, but those in PPOs may be balance-billed. State law requires PPOs to disclose the possibility of balance billing to consumers and allows consumers to pursue dispute resolution for amounts of $500 or greater. Also, PPOs must base payments on usual and customary billed charges in emergency settings or those where no in-network provider is reasonably available. This minimum payment amount is designed to minimize the use of balance billing."
https://www.commonwealthfund.org/blo...alance-billing
scroll down for a map of the states, click on the states to find out current law.
" In Texas, HMO and EPO members must be held harmless, but those in PPOs may be balance-billed. State law requires PPOs to disclose the possibility of balance billing to consumers and allows consumers to pursue dispute resolution for amounts of $500 or greater. Also, PPOs must base payments on usual and customary billed charges in emergency settings or those where no in-network provider is reasonably available. This minimum payment amount is designed to minimize the use of balance billing."
Oct 29th 2019, 4:53 pm
#62
BE Enthusiast
Thread Starter
Joined: Jun 2011
Posts: 388
Re: Healthcare - out of network expenses
UPDATE - I post this with all fingers and toes crossed, but it looks like the two bills that we had amounting to $11,000 have been reduced to approx $200. We were corresponding with the health insurance broker, and they have explained that the hospital worked with a specific out of network anesthesiologist and then wrote off the non contract rates. I don't know if this was the hospital's intention all along or whether it was anything to do with the broker getting involved but it is a huge relief. More importantly, Mrs NewAdventure has finished chemo and is doing ok and looks rather fine with a #1 haircut (she did make the family watch Aliens3 though). We are getting ready for mastectomy op on Monday. Thanks everyone for support and helpful comments over the last few weeks
Oct 29th 2019, 5:35 pm
#63
Often not so civil...
Joined: Apr 2010
Location: The Boonies, GA
Posts: 9,561
Re: Healthcare - out of network expenses
Great news! 
Good luck to Ms newadventure for the future.
Good luck to Ms newadventure for the future.
