When we are about to have surgery at a hospital or outpatient surgical center, we usually check for network status of the facility and surgeon, to be sure we are getting the best benefit for that service. As we know, staying within the network of our plan will result in lower cost sharing for us.
It is important to remember that some services during that surgery may be performed by an out-of-network “ancillary” provider. Examples may be anesthesia, imaging, and lab, to name a few. When the claims are processed for those providers, we may end up with a balance bill that has been applied to out-of-network deductibles, vs. the in-network benefit. This can mean a difference in several hundred dollars in bills for the patient.
We advise our customers to review these bills when they come in, and always call the insurance company to see how they were processed. Obviously, patients have no control over who performs these ancillary charges, and therefore, should not be penalized with higher out- of- pocket costs as a result.
Our employee advocate service is available to help with these types of issues, if the insurance company is not willing to adjust the claim. We have a very high success rate on appeals for out-of-network ancillary charges. Customers should always double check surgical bills, and challenge them if something doesn’t appear to be correct.