Surprise! Your anesthesiologist is out-of-network

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By Consumers Union on Thursday, August 28th, 2014

Lisa N. from Santa Cruz, California, wrote to us sharing her medical bill-shock story from a recent pregnancy. When the time came, Lisa checked in to her local in-network hospital and used her in-network gynecologist and the approved in-network neonatologist. She hadn’t been planning on getting an epidural, but ended up needing one. “Did I need pain relief? Yes, most definitely yes,” says Lisa. “I left the hospital with a healthy baby, 10 hours after entering it, totally unsuspecting of what was to come in the mail.”

Lisa told us she eventually found out that the anesthesiologist worked at the hospital, but was considered out-of-network.  She got a copy of the full bill, even though she had insurance.  The hospital stay worked out to be about $1,000 for the room and nursing services, $1,000 for the doctor and the delivery, and $3,000 for the out-of-network anesthesiologist. Everything was covered under her insurance, except the most expensive thing: the anesthesiologist.

Even worse, Lisa says, “I eventually found out that there were zero in-network anesthesiologists at that hospital.”

“In this situation, when you really need pain relief, and the anesthesiologist is called in, I don’t know anyone who would be capable of asking “Are you ‘in-network’?” Lisa continued. “The anesthesiologist is the most expensive part of labor and delivery – and in the situations where you need anesthesia, you aren’t going to ask if they’re in-network. They totally have you over a barrel.”

Lisa’s not the only one – many consumers have written to us about being surprised by an out-of-network bill, or being given wrong information about which doctors are in a plan’s network. We know from stories like these that provider directories can contain errors and wrong information – and  that even doctors sometimes don’t know what networks they’re in.

If something similar has happened to you, we want to know about it  so we can help make health insurance easier to use for everyone.  Share your story here.

17 responses to “Surprise! Your anesthesiologist is out-of-network”

  1. Michael O says:

    My wife and I went for a colonoscopies, that were supposed to be covered 100%, and specifically asked at the clinic scheduling if the anesthesiologist was in-network, me one day and her the next. Yes, I was assured. The morning of the procedure I asked again at the front desk. I asked my insurer but they said anesthesiologists all change so you have to ask at the clinic when checking in: they can’t answer in advance. Yes: your doctor, anesthesiologist, and clinic are all in-network the clinic assured me. You can see where this is going: a separate bill for the out-of-network anesthesiologist. I was livid, refused to pay or negotiate, and still refuse to pay. I told them sue me; it’ll be interesting to find out in discovery how many people you do this too in preparation for a counterclaim. They went away but still left the bill on my credit report. Some doctors, clinics, and hospitals are purposefully misleading patients to balance bill at higher than negotiated rates.

  2. joe mama says:

    Dan is an F’n moron. Go get your surgery somewhere that has a tech administer you anesthesia and see if you wake up you dipstick. Insurance companies are to blame for this, not the doctor who charged you $3000 to keep you alive. you have no clue how healthcare works. Medicare pays anesthesiologists an average of $150/hour during a procedure. that would not even cover the overhead for a physician, because there is so much down time in between surgeries. So, in an average day, the anesthesiologist actually can only administer 4-5 hours of anesthesia. Thats about $600/ day. thats peanuts for the amount of training and school debt. you pay more for a lawyer per hour. Insurance companies force physicians to take a huge cut in income to be in-network because they can control where patients go. to the point that some hospitals require anesthesia groups to go in-network and accept a horrible pay rate, but the hospital has to make up the difference with giving the anesthesiologist a stipend in oreder to recruit physicians to work for peanuts.

  3. Anony says:

    Was scheduled for surgery and had through go my doctor’s surgery scheduler – doctor was in-network. Much to my surprise I received a surgery information package and low & behold hidden in the paperwork was a form from anesthesiologist group that informed me that they were non-network but yet would do everything to be reimbursed by insurance company. It was anticipated that there was to be some level of home care/rehab – again scheduled through doctor’s office but was NEVER INFORMED of amounts. Never got Estimate of Benefits but doctor’s office was sure “quick on their feet” to schedule surgery. I cancelled before 5 days as doctor’s office now will charge patients a $250 cancellation fee. Sounds like a “real money making operation” especially since I couldn’t get the EOB. If doctor’s office is doing the scheduling then THEY SHOULD ENSURE in-network providers are used – this should apply to hospitals as well. Will be looking for a teaching hospital with doctors and other providers in network. The way these types of procedures and providers are handled in the medical community can subject a patient to financial ruin.

  4. […] The surprise charges in healthcare often upset people… for example, they learn that the surgeon and the hospital are “in-network,” but the anesthesiologist was not. […]

  5. Steph says:

    The RN who assisted in my C-section was out-of-network costing us more than everything else combined. Our hospital stay, OB, and anesthesiologist were all in-network and covered and our final bill came to just over $3000 for the 4 days my son and I spent in the hospital. Then, months later we received a bill for $3200 for an out-of-network RN that was working at my in-network hospital and I didn’t even know was in the room.

  6. M. L-F says:

    After a serious bike accident, we let insurance know he would need surgery ahead of time and were told the hospital was in network. Now bills are coming and they are claiming the anaesthesia was out of network. That makes no sense and should be illegal. How could a patient know they would be billed separately from the surgery and how could a patient know how to get the anaesthesia in network when the surgery itself was covered. Clearly this Is unconscionable and is done intentionally by insurance companies so they have to cover less. The bigger question is what we can do about it?

  7. Jeannie says:

    This feels a whole lot like consumer fraud. My insurance states a free colonoscopy. That’s all I had done. Now I have to pay a fee because the anesthesiologists isn’t in the plan. I made sure the doctor as well as the hospital were in my plan. If this were an emergency; how is a normal person expected to stop and ask if the anesthesiologist is in the plan. Farha, I’d file a complaint with the consumer protection agency. Here’s their website, https://www.ftc.gov/about-ftc/bureaus-offices/bureau-consumer-protection

  8. Susan Lovasko says:

    In September 2016 I had outpatient surgery at a facility that was in-network as was my doctor. Once the bills came in I found out that the anesthesiologist was not, so that full amount I was responsible for. The kicker was that if I didn’t have insurance they would discount it for me. But since I have insurance, no chance of discount because that would be considered insurance fraud. Can’t win.

  9. […] the meantime, the horror stories continue. Take this one reported on by Consumers Union: A Santa Cruz, CA., woman about to deliver a baby checked in to her local in-network hospital and […]

  10. […] the meantime, the horror stories continue. Take this one reported on by Consumers Union: A Santa Cruz, CA., woman about to deliver a baby checked in to her local in-network hospital […]

  11. Ravinder says:

    Dan , please dont say Anesthesiologists are NOT God. because without him surgeon can’t do anything even you dont allow him to touch with his/her tools. and if the ration of anesthesia imbalance little bit it patient cant go into comma or paralysis.

  12. Ravinder says:

    See, Don’t get Shocked if the Anesthesiologists billed as Out of network when you checked in-network hospital and used her in-network surgeon or doctor. because you have a choice to chose hospital or surgeon not Anesthesiologists . So If Facility is in – network Insurance need to process the Anesthesiologists OON claim in – Network under RAPS provision

  13. James McBride says:

    My wife had out-patient surgery for tennis elbow. The doctor and the clinic were all in-network. We made sure of that. To our surprise, the anesthesiologist was, of course, out of network. In the past, on surgery I had, our insurance company had treated us as if the anesthesiologist was in-network, and we owed no addition money. But no more. Now they helped out and enhanced the payment as if the doctor was in-network, but we were back-billed for $525. The insurance representative explained to me that they have to do business that way now because: anesthesiologists have largely stopped subscribing to insurance networks and because of the Affordable Care Act (Obamacare). I’m not sure if Obamacare affected the doctors or the insurance companies, or both. Anyway, the cost went up for us. Without the help from our insurance company, our bill would have been over $1200.

  14. farha majeed says:

    My insurance is reviewing my account n may cover 20percent only…as patients v barely use anaesthesia but the hospital uses this facility many times in a day…it would b ethical to mention to unsuspecting patients that anaesthesia is billed separately…

  15. farha majeed says:

    Hi,just wanted to kno is there any way out from the anaesthesia bills?? I had to take anaesthesia fr labor pains n then again fr endoscopy…i had no idea..n now keep getting bills $2400 and $3190 respectively…i m also put thru stress every now n then with early morning calls from different billing centers…

  16. Dan says:

    Anesthesiologists are NOT God. They should not get paid more than the surgeon that did the actual procedure (i.e. brain surgery, heart surgery, etc.) All they actually do is administer and monitor the anesthesia flowing through the computerized machine that actually dispenses the anesthesia. If something goes wrong during the surgery, the surgeon gets the scrutiny, never the anesthesiologist. He always get away scott free. Yet he feels that he is worth more than the actual surgeon. Check this out. An anesthesiologist works in a hospital surgical setting. If all hospitals require that anesthesiologists contract and accept prevailing medical insurance plans, this would bring anesthesiologists in line with all other medical personnel. This should be a requirement by every hospital. If the anesthesiologist chooses not to participate, then he has no job….period. Since computerized medical equipment now controls anesthesia flow to the patient, specialized technicians can do the same work for a whole lot less. Medical technicians are trained to administer X-rays, administer chemotherapy, perform dialysis, and other life-saving procedures. When properly trained, they are fully capable of entering into the computer the: body weight, height, age, weight, sex, etc. of the patient. The computer will then administer the proper anesthesia to the patient. The computer also monitors and warns when attention is needed. What is needed is national and state legislation requiring that hospitals accepting medical insurance assure patients that their insurance will be accepted by all medical personnel tending to their care. If the anesthesiologists don’t accept the terms, they will have no place to practice their profession. Again, they are not God. It is about time their bubble is broken and they are brought in line with the rest of the medical profession.

  17. Marvin Miller says:

    Does CR evaluate and publish rates Hospitals charge the uninsured as compared with how they bill the unsurance companies? The rates for uninsured are often much higher, correct? Are there any states that have laws that require the hospitals to charge the uninsured at the average rate that hospitals bill the insurance companies?

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