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In December of 2021 I had elective surgery. The night before my surgery I called the hospital to double-check that they were in-network and was told that they were. A few weeks later I got a big bill because they were out-of-network. Our family had met our in-network out of pocket maximum for the year and so the surgery should have been free.

I've called several times to try to negotiate the bill, explaining that I wouldn't have had the surgery if I'd known that they were out of network. The first person that I spoke to didn't seem to think that the bill was negotiable and said that he would send it to the Billing Department.

I called back today and was told that the Billing Department had come back and said that I was responsible for the bill. She said that had the surgery been this year that I would have been covered by the "No Surprise Billing Act," but because it was last year that didn't apply.

I'm wondering if I should drive to the Hospital if I would be able to find someone who would be willing to negotiate the bill down.

Does anyone have any suggestions on how I could go about doing this?

Thanks

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    Lesson learned: don't ask the hospital whether your insurance covers it, ask the insurance. Generally for elective procedures you'd want to have a preapproval from your insurance.
    – littleadv
    Mar 30, 2022 at 21:09
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    Has this bill/claim been submitted to your health plan at all? Do you have an EOB indicating out of network coverage? Obviously plans will only cover “covered procedures” so even if your procedure was elective you can generally sort out any procedural missteps for a covered procedure like prior authorizations after the fact with your plan, if this was “cosmetic” or the like it’s a whole different story and wouldn’t be a “covered procedure.” In-network wouldn’t have any bearing on whether something is a covered procedure. But you need to talk to the health plan.
    – quid
    Mar 31, 2022 at 3:02

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Surprise bills refer to in-network hospitals with out-of-network doctors who consult on your case. Examples of these specialist doctors are pathologists and hospitalists.

Check with your insurance company (e.g. check the website) to see if your hospital is in-network or not. A surgery itself should not be a surprise bill, only the ancillary services. Check each doctor or medical group on your bills to see if they are in-network.

Once you're sure you've categorized the services correctly as in-network and out-of-network, you can ask each billing entity for a discount in exchange for paying immediately. 25% discount might be possible. Or, you can request a payment plan from each billing entity.

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