OP Patient Advocate (old timer, 2000 posts) Joined: May 2002 Posts: 2,152 | I was surprised when I read something in the 'HEAL' magazine about the cost of treatment and it mentioned that you may be billed the difference for some treatments as out of network while you are in an IN NETWORK facility and thus have to pay at a higher bill.
While this IS true, I have found that it is often caused by the pathologist/lab/anesthogist/rad/,etc. bill arriving before the facility bill, but even if that is not the cause, if I call the insurance company once the facility bill is in, they will adjust it back to IN NETWORK and reprocess. I have never had to pay the difference for an OUT OF NETWORK charge when I was at an IN NETWORK facility as the article indicates. This has worked for me at both CIGNA and AETNA and I imagine is true with other major insurers.
If the insurance company refuses to adjust, I would ask the facility to write it off. You have no control over who the facility used to process/read the whatever, so unless you were OUT of NETWORK to begin with, I don't think you need pay the difference.
It works for me, give it a try.
Take care, Eileen
---------------------- Aug 1997 unknown primary, Stage III mets to 1 lymph node in neck; rt ND, 36 XRT rad Aug 2001 tiny tumor on larynx, Stage I total laryngectomy; left ND June 5, 2010 dx early stage breast cancer June 9, 2011 SCC 1.5 cm hypo pharynx, 70% P-16 positive, no mets, Stage I
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