Michael

The practice nurse may not be listed as in network but the center may be listed which means all who practice there are covered as in network. This happened to me when I used a doctor who practiced at Stanford hospital that wasn't listed but was covered as in network since the hospital was covered. Of course if the practice nurse is only a visiting nurse, then he/she would be out of network and your deductible starts again from $0 with a larger co-pay.

Jerseygirl

We normally don't receive any invoices. I think it was because the group practice nurse was out of network...even though the cardiologist she works for is in network. My husband was booked to see the cardiologist...but due to an emergency his practice nurse stood in to give my husband the results as they were straight forward.

Group practice nurse.

Yes you would think it would cover her...especially as she was the person who adminstered the nuclear stress test...not the cardiologist and the insurance company have paid that bill.

Michael

Call the insurance company. They probably don't have her associated with that center according to their records and the bill came directly from her with no reference to the center. The first bill probably referenced the center.

Jerseygirl

Hubby's been onto the practice...they are going to sort it out. If not they will lose our business.

MsElui

the surgery was in January so its just this years deductible (although some of the MRI scans were in December so he had to pay a $150 deductible for those). We did try and get the surgery done in December when he was diagnosed because the health insurance policy we were on for 2011 was a lot more generous and our deductible would have been far far less. However the physio would have run into 2012 so we would have needed up paying for that anyway. At least this way we know what we owe for 2012 and we can see if there is any other surgery he needs in the next 11 months whilst the deductible is fully met.

MsElui

i also forget to mention - he has been 'loaned' a special chair contraption by the surgeon to help rehabilitate him. It has a special robotic arm that he has to strap the affected arm into. Then its programmed to slowly raise and lower the arm to a set amount of degrees. Hes supposed to sit in it for up to 6 hours a day. Each day it increases the angle a little so its improving the stretch and avoiding scars forming (apparently). He wasn't given any choice in the chair - the surgeon just arranged for it and it was delivered. So I expect we will get a nice little bill for the 'loan' at some point.

Ja5on

One of the problems is that the Doctors don't know much about the cost of things.....My wife is a resident and she just tells people what they need doing or what tests need to be done, she doesn't even understand our own insurance let alone any of her patients!

scrubbedexpat099

This and many other of the other replies is an exellent summation of what is wrong with the US system and the UK for that matter.

avanutria

That's a relief! And good idea checking into any other needed procedures while you've got the deductible met.