Question
What is the name of your state? Florida
I had surgery in a hospital that was in my plan's network. The anesthesiologist was out of network, but accepted assignment and was paid in full for the reasonable and customary charge by my insurance plan. Now the anes. is billing me for the balance of their charge, which is twice the R&C charge. Can they do this? By accepting assignment and payment do they forfeit the right to bill me the balance? I'd like the Florida law that covers this situation, so I have ammunition to argue.
Thanks.
K
Answer
Anesthesiologists are almost always out of network and never agree to discount their fees. Your carrier paid R&C but the anesthesiologist is not obligated to accept their fee as payment in full. You may negotiate with the doc if you like, but if he/she does not lower their bill you must pay the difference.
To my knowledge, there is no FL law that governs your case. If the anesthesiologist has a signed contract with a MCO or your carrier, or if he/she has stated in writing they will not balance bill, then you have a basis for your stance. Otherwise, pay up.
Answer
pay up? It's easy for you to say, not your money... Unlike any other situation like it, soundls like this ******* never told OP how much his services would cost. And, to top it off, there is really no way to determine what exactly was rendered. Unless he is the best specialist under extraordinary circumstances, he is way out of line on this one. I typically see 20-30% markup, not more.
Answer
Unlike any other situation like it, soundls like this ******* never told OP how much his services would cost. Unless he is the best specialist under extraordinary circumstances, he is way out of line on this one. I typically see 20-30% markup, not more.
Sounds like the OP never asked about pricing.
As for how much a specialist should charge, that is up to the individual rendering services, regardless of what you think is fair.
Answer
Florida
Thanks everyone,
I had hoped that there was some agreement implicit in the "accepting assignment" part of the process. Maybe I should check with my carrier to see what, if any, conditions accompany the assignment/payment. Should my carrier have sent the payment to me instead of the out-of-network provider or did I probably sign something in admissions re the assignment?
K
Answer
I had hoped that there was some agreement implicit in the "accepting assignment" part of the process. Maybe I should check with my carrier to see what, if any, conditions accompany the assignment/payment. Should my carrier have sent the payment to me instead of the out-of-network provider or did I probably sign something in admissions re the assignment?K
If there is anything implied (in accepting assignment), it would be in the paper work you signed for the provider. The provider is not party to any agreement with your carrier, nor the network that is rented to your carrier.
If you requested assignment of benefits, why would the carrier send the funds to you?