Medical Appeal

Anyone had success appealing to GHI or out-of-network doctor on a balanced bill?

The tending anesthesiologist during my delivery is out of network and sent me a balanced bill for 3k. The insurance provider, GHI, sent me a check for $500 which I forwarded to the anesthesiologist's office.

The anesthesiologist subtracted the $500 I forwarded them and sent me another bill for $2.5k. :(

When I pleaded, they reduced it to $1200.

Has anyone had success writing a letter to get a doctor to just accept an amount paid (in this case $500) as payment in full? Or success in getting the insurance company to fork over more money?

TIA!

Re: Medical Appeal

When I had DS#1 the doctor that does the hearing test in the hospital was out of network and sent me a bill for over $1500. I called my insurance provider (Aetna at the time) and explained that I was not given a choice of doctors, that was who the hospital used. Because of that I was not responsible for the billl. I would call GHI and explain that you were not given a choice of doctors. You shouldn't be responsible for paying it. Hope this helps you! Good luck!

Re: Medical Appeal

Thanks, it gives me some hope?

Does any know how willing GHI is in paying a balanced bill from an out-of-network provider?

Should I just try to negotiate down the bill and pay it and hope GHI can reimburse me? I have heard this medical provider I am dealing with is very claims court-happy.:P