out of network just means you don't have a contract with the insurance company. Normally when you are in network you have a set reimbursement for various CPT codes and timed units. When you are out of network, you don't. So when a patient has surgery, instead of directing billing their insurance you are sending the patient themselves a bill. And you send a bill for your full charge amount, not the normal insurance discounted amount. And then the patient is supposed to submit it themselves to their insurer for reimbursement or just pay cash. Insurance companies will often then just send the patient a check to cover it and then the patients are supposed to forward the money on to the doc which they often don't do so then you have to try to scramble to collect.
It's painful all around.
Isn’t this the tactic some insurance company will have you join?
So the hospital is alleging, it is losing business because patients won’t come.
1. Patient wants the insurance company to pay, so they don’t have to.
2. Patient thinks that out of network rate will not be enough to pay the whole anesthesia bill.
I think there’s a lot of assumptions at play here. I also think what
@SaltyDog said also should be considered too.
On top of that, if the surgeon has a choice to operate at another place, they may consider that too. If i only want to operate, I certainly don’t want to ever hearing my patients social/economical/insurance complaints.
As an anesthesiologist, I certainly can understand I want to get paid for what I do. As a consumer, I also understand, I don’t really want to deal with the logistics of coordinating every single aspect of my care.
I thank you and everyone who have contributed to my understanding of all these ****ty issues....
