Insurance question.

[Bigdave]

Before surgery, I had contacted my medical insurance carrier re: making sure my urology office was in-network, they are.
They also pre-authorized the surgery, and my payment was to be the remainder of my $3000 annual out-of-pocket limit, which I paid in advance of surgery.

Today, I got an invoice from the urology office for over $45,000 in remaining balance. Needless to say I was shocked.
The total bill was over $75,000, including a charge of $50,000+ for "supplies".
The insurance paid only around $27,000. WTF???

It's my understanding that an in-network doctor has agreed upon rates with the insurance co.
Has anyone else had their insurance company underpay their doctor, and try to stick you with a bill of 16x what you were told?

Thanks.

[Floridaspeedo]

Never. Confirm the Dr and hospital are in network. It may just be a simple billing mistake.

[KeithC]

Hopefully that just an error. When I got mine the hospital showed me a document with a $92k figure on it.

My insurance paid right around $20K for it total.

[Gt1956]

Look carefully for an * or a footnote. Normally either of these 2 items will give you some fine print explaining that the hospital accepted a contract payment as payment in full. They are loath to actually tell you what was paid. They view it as a business secret not to be shared outside of the 2 parties.
I've read stories several times by reporters trying to figure it all out & they always report running into a stonewall of silence.

[Old Guy]

Shocked is the word alright. Holy Crap, even paying out of pocket I see guys saying 20-40K.
Looks like you need to make a few phone calls.

[Agfa13]

Yeah, sounds like a billing error. Either way, just verify.
I found out the hard way (no pun), that when you go in for minor/major surgery of ANY sort, verify ALL participants (Dr., nurses, Anesthetists, etc...) are ALL in network. Colonoscopy was covered, but Anesthesiologist was NOT In network....$1700 for an hour's work. They have to make their money, but you have to check up on them!
My 2 surgeries for my implant...out of pocket was $12K, total $68K. Following year for the 3rd implant, $6K. I got off lucky with insurance.

[Bigdave]

Thanks for the responses.
I called my insurance company this morning, and after he checked with the doctor's office, he called me back and said that bill was mistakenly sent to me.
The billing is still in progress and everything with the insurance is not settled yet.
He also confirmed that my $3000 out-of-pocket limit is met, and I should not be responsible for any more charges this year.

I'm quite relieved. LOL

[Old Guy]

Thanks for the responses.
I called my insurance company this morning, and after he checked with the doctor's office, he called me back and said that bill was mistakenly sent to me.

I'm quite relieved. LOL

WOW, that's good.
Wonder what they would have done if you went ahead and paid it.
My co-pay was around $3,700, some for the surgery center, some for doc. Couple months later I get an envelope from the surgery center, looked like a bill. Started to panic until I opened it. Guess insurance settled with doc's office and they refunded me almost $600. YAY!

[sswinsfba]

OP: Glad you got your billing "problem" cleared up.

As you've now learned, what is billed for medical "care" can be dramatically different from what is actually paid.