My son had an endoscopy last September. Evidently, the anesthesia service just got around to submitting the clam in April.

The total is $1890, and all but $142.41 of it is being denied as out of network. I haven't gotten a bill, yet, but I suspect that's coming.

However, ALL of the other bills I got related to this procedure WERE covered as in-network (and paid in full because we'd hit our deductible). In particular, the doctor's office/provider that ordered the procedure in the first place was in-network and the facility where the procedure was performed was in-network.

I'm gong to call tomorrow, but any advice on how to dispute this? I thought insurance companies weren't supposed to deny anesthesia claims like this anymore because it's not like you can ask if the anesthetist is in-network or not when you're about to be knocked out. I mean, what else is a patient supposed to do besides use a doctor and a facility that are both in-network?

It's unfortunate, but it's still an ongoing issue.

A lot of people assume that if your hospital accepts your insurance, then all of the doctors in the hospital will too.
Many people are unaware that many doctors who provide services in a hospital are not hospital employees.

For instance, many ER doctors like myself work for and are employed by a separate company, and the hospital contracts with us to keep their ER staffed. The insurance contracts we use and networks can be different. My particular group has worked very hard to be in network with the "Big 5" (Aetna, United, BCBS and others), but not all contracted groups are the same. Anesthesia and Radiology are two that are very frequently contracted, like ER as well.

Yeah, I'm familiar with the contract services. He broke his arm a few years ago, and I was paying bills for all sorts of different contractors (the Dr who read his x-ray was in Oklahoma). I just didn't think insurance companies could refuse to pay in a situation like this. We did everything we could to stay in-network. It's not like you can choose who administers anesthesia before a procedure.

I'm hoping when I call tomorrow they will tell me this is some sort of administrative mistake. He had the procedure out of state (he's in college), and maybe this is just a communication error between BCBS TX and BCBS MS.

Unfortunately insurance contracts are also different state to state, and region to region.
Rather than admit to an administrative mistake, they'll probably stick to a loophole not to pay if they can.

Call and talk to them though. See if you can negotiate with them. There's also an arbitration process that while not easy is for disputes like this too.

Well, this had an interesting resolution...

Called BCBS TX who called BCBS MS, and MS said the anesthesia provider is not in network. They gave me the actual name of the person associated with the bill (my EOB doesn't have that info).

I googled the name of the anesthesia company on the EOB and got a phone number. When I called the number, it ended up being the doctor's office. The woman I talked to there said that is the anesthesia provider they use, but she said they ARE in network, and "This happens all the time - you probably don't owe any money." Then she gave me the number of the billing service for the anesthesia company.

Called that number, and they confirmed there is no balance on my son's account. The insurance company appears to have paid $142.41, and they area accepting that as PIF.

None of this makes any sense, but I am relieved I don't owe $1750!.

Glad it worked out