civilservant

If she was a Nurse Practitioner they usually bill separately, so totally could be out of network.

scrubbedexpat097

That's true. I'm sure only a NP would have been given the job of explaining results.

SanDiegogirl

Some years ago I had knee surgery and afterwards found that the anesthesiologist was not in network - as if one checks everybody who might be working on you!
Queried this with the medical group billing me and my insurance. The charge got dropped to in network.
Also have had bills whereby the ambulatory facility where the treatment took place was not in network. People were, building wasn't !

Jerseygirl

Over the years we have had many similar stories on hear. Unbelievable I know.

scrubbedexpat097

I think we are beyond unbelievable now. It doesn't shock us anymore we just know that on every medical bill we get there there will be something unexpected that we either have to challenge or pay up before the bill goes into collection.

It is a crazy system.

Lion in Winter

Wait - you ok there?

I mean on the health, not the bill.

Steerpike

Having some weird heart, and also head, issues. The issue started when I had spells of 'difficulty concentrating' while driving about a month ago (for which I ended up checking into an ER in the middle of nowhere), but now are quite frequent - daily. The feeling of being 'distant' correlated to the sensation of my heart beating oddly. The ER found nothing and suggested seeing a cardiologist. Cardiologist gave me various tests, and fitted the 'extended Holter Monitor' for 3 days. The monitor detected SVT - SupraVentricular Tachycardia - basically, heart pumping irregularly and too fast. 30 such incidents monitored during 3 day period, worst one lasting 15 beats (don't know how severe that is in the scheme of things). When the heart pumps irregularly and fast, the blood doesn't keep up so you end up with too little oxygen to the brain, leading to light-headedness. The cardiologist said he would normally prescribe some medication to address the SVT, but I also have very low blood pressure so he can't risk that; so he now wants me to see an 'ElectroPhysiologist' - 'heart wiring expert'. I've also cut out caffeine, which sucks!

The periods of light-headedness/inability to concentrate/'brain fog' are now occurring quite often and lasting quite a long time, so I saw a neurologist who has recommended the MRI to see if there's anything going on there.

All this is very new to me, having gone 60+ years without any significant incidents (though did have a 'heart scare' ~7 years ago with chest pains, but that was a one-off, and have complained of 'brain fog' off and on for a few years). I do wonder if the C-19 vaccine is somehow related, being the only significant change recently (I'm no conspiracy theorist, and have my booster scheduled for next week, but it seems like the vaccine has some correlation to heart issues). I've been hiking 4 miles a day for 10+ years and work out at the gym, which I'm still doing, just taking it a bit easier.

A self-inflicted complication is that my insurance coverage is in AZ but I'm in CA for the month of December for the holidays, so can't see anyone in person (just had a 'telehealth visit' with my cardiologist, and chose to pay cash for the MRI next week). I now have to decide whether to re-base my insurance in CA for next year, and also start giving some consideration to giving up on AZ altogether ... if I can't safely drive between the two locations, not much point keeping it (Covid has made flying an unattractive option). Must decide before Dec 15 (d-day for 2022 insurance).

hutchison

I visited a dentist in SEP 2020, regular hygiene appt with x-rays, I had asked if there was a bill when I NEXT visited the dentist (1yr later) because no EOB had come through, they said we are still waiting on insurance. One month ago (13 months later), I received a cheque for $220 from the dental insurance providers (part of my health insurance), I asked the dental insurance provider why they sent me a cheque for having a check up, they said its because the Dentist Dr , at the time, was not IN Network, was a new hire, and not registered/approved yet at that dental surgery,

that left me with a quandary and no instructions, what do I do with the cheque?, so I paid the dentist who still has a balance on my account for that sum. Apparently it happens when the service provider uses someone out of network, and according to the terms of their service contract with the dental insurer, the dental (or other insurance enrolment) will send a cheque to the patient. its possible that the insurance provider is putting pressure on the service provider to be in network, for what reason? perhaps to pay out cheaper claims to the service providers.

either way , I am not totally sure if legally I could have kept the payment, however, morals kicked in.


other info:
it has not happened (received cheque's) on all my 'out of network claims', other enrolment areas of health insurance certainly did not send us cheque, instead the 3rd party vendors have just tried to bill us direct, we threw them out in most cases as the doctors requested those services, and did not inform us after we explicitly requested IN networks (emergency OPS last year, but time enough to make requests)

Lion in Winter

Well that stinks, sorry to hear things have got complicated.

Not a medical person here, but everything I've read says that any heart-related issues stemming from covid vaccine occur within hours and are gone in a few days, so with any luck it's not that. I'm sure you've googled, but google also tells me that all sorts of things can cause that, but if you have simple electrical misfires there are some very good procedures to fix it.

Good luck with it all. I know you're super fit so you are in good shape to sort this all out.

Lion in Winter

Also, perhaps it's possible that you had actual covid and have some fallout from that.

Steerpike

I did give that some thought since Covid seems to have many mysterious effects, and got a proper PCR test a month ago to rule that out; came back negative. I also had a PCR test back in June 2020. Of course, I could have had it between the two tests, but I've had zero indications of any problems other than this recent development.

scrubbedexpat097

Hope your docs can figure out what is happening and come up with a soloution
Are you doing the stand up MRI or just the open one?

As for being caffeine free, I hear you. I am now 8 weeks free but still crave a real coffee some days. It sucks!

durham_lad

Steerpike Sorry to hear about your heart issues, I have been through similar myself. Started while we were living in Houston over 6 years ago when I was age 60. Up to that point I had been super fit and played singles tennis until back and knee issues finally convinced me to stop, just a few months earlier.

The cardiologist said that it was simply my age and that I’d be surprised how many athletes he had on his books with arrhythmias. 3 years later, back in England, I was referred to an electrophysiologist. While I do have SVT like you, I also had AFIb which was fixed just over 3 years ago by an outpatient procedure.

These electrophysiologist guys are excellent at sorting out electrical heart problems. Hopefully you will do very well. As Bette Midler once said “Growing old is not for sissies”

as for being hit with out of network procedures when you have been careful to go to a facility that is in network, it used to drive me nuts.

SpoogleDrummer

Moving to another state is a life change that will re-open enrollment for you again so you have all the time you want.

Steerpike

I was a classic workaholic until I was just over 50, happily working away all day and never exercising (miraculously, staying skinny). My doc convinced me I needed to exercise for the benefit of my heart, so I took up hiking, and loved it. When I first started, I was totally out of breath but my 'cardio' system adapted and I could then hike for miles at a fast pace and hardly felt anything. Recently I started going to the gym also, working on body strength and 'core' issues. The 'heart' issues seem to have started with the gym activities, coincidentally or not. So on the one hand, it seems the exercise 'improved' my heart function, but then, I wonder if it may have also caused the 'electrical' aspect to get messed up. I was so pleased with my added gym routine but now I'm not so sure ...
I filed a formal 'appeal' to the $3,500 charge with the ins. co, and also pursued it with the cardiologist. I already got a call from the cardiologist saying they would reverse the charge, but I haven't seen a reflection of that on my insurance 'page' yet.

I'm aware of that concept, and realize that I can 'move' at any time, but - I also want to see the ElectroPhysiologist (EP) in January, and need to decide where that will happen. I will be in CA at the start of Jan, and if I could be sure to get to a specialist right away, I'd switch insurance to CA; but I'm already well into the process in AZ, having seen the Primary Care Physician and the Cardiologist there, and already have the referral. And once I see the EP in either location, logically I need to see the process through in that location. I have to be in CA in early Jan, and again in March, but I plan to be in AZ in late Jan and Feb ... so timing is complicated. I can't really start calling EP's in CA to find out availability until I get insurance in CA I don't think (first question you get is always about your insurance).

Anyway - do you happen to know, if you move 'mid-year' as allowed, what happens to your deductibles, etc? Do they all re-start at zero when you move to a new insurance company?