{"id":353,"date":"2012-12-04T07:41:00","date_gmt":"2012-12-04T07:41:00","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/rebeccafrech\/2012\/12\/the-in-networkout-of-network-scam.html"},"modified":"2014-08-22T15:47:56","modified_gmt":"2014-08-22T20:47:56","slug":"the-in-networkout-of-network-scam","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/rebeccafrech\/2012\/12\/the-in-networkout-of-network-scam.html","title":{"rendered":"The In-Network\/Out-of-Network Scam"},"content":{"rendered":"\n<\/head>

Once upon a time, I thought that the way health insurance worked was simple.\u00a0 If you got sick, you found a doctor or a hospital on your list of providers and you went to them, because they were the ones in-network.\u00a0 It all seemed so simple, in theory, that I would hear tales of people going broke when they got sick and think \u201cThey must have been sick for a really long time.\u201d or \u201cI wonder why they didn\u2019t go to someone on their insurance.\u201d or most often \u201cThat\u2019s really sad, but it won\u2019t happen to me.\u00a0 We\u2019ve got great insurance.\u201d\u00a0 In my naivety, I didn\u2019t understand that people were going broke after one or two days in the hospital.\u00a0 I didn\u2019t know just how difficult it really could be to navigate through the in\/out of network maze.\u00a0 I honestly had no idea\u2026and then #4 got sick.<\/p>\n

She woke up one morning with her toe all swollen and purple, but it didn\u2019t hurt and she couldn\u2019t remember hurting it.\u00a0 I took her to our family doctor (in network \u2013 $20).\u00a0 He confessed that he had no clue what was going on, but thought it might be broken, and sent us for an x-ray which had to be read by a radiologist (both in network, combined \u2013 $45)\u00a0 It wasn\u2019t broken.\u00a0 We decided to watch it for a day or two and see what would happen.<\/span><\/span><\/span><\/span>
Her knee swelled up a few nights later.\u00a0 We took her back to our family guy (in network $20<\/span>).\u00a0 He was more confused than ever.\u00a0 He sent us to an orthopedist (in network $20<\/span>).\u00a0 He asked for an MRI of her knee (in network \u2013 $225<\/span>) <\/span><\/span><\/span><\/span>
The knee swelled up even more and got hot to the touch.\u00a0 I called our family guy, who agreed with me that this sounded as if it might be an infection in the joint, and sent us to the ER at Children\u2019s Hospital ( ER co-pay in network $100<\/span>) ( ER in network \u2013 $1,167<\/span>)\u00a0 The first doctor we saw ( out of network $325<\/span><\/span>) didn\u2019t know what was going on, so he called in a colleague to look at her ( in network \u2013 included in ER co-pay<\/span>).\u00a0 They decided that they wanted to see an ultrasound of her knee to determine if the swelling was water or pus. ( in network \u2013 included in co-pay<\/span>) The film had to be read by a radiologist we never saw ( out of network \u2013 $2,143<\/span>)
The fluid was fluid and not pus.\u00a0 The ER doctor decided that it should be drained and analyzed. He called in an orthopedist ( out of network \u2013 $417<\/span> <\/span>) who pushed and poked at her knee for a good bit before declaring that he was uncomfortable draining it himself. He called in a different orthopedist ( in network \u2013 $115<\/span>).\u00a0 He asked for her to be given anesthesia first\u00a0 (pharmacy- in network \u2013 $187<\/span>) He sent the fluid to the lab (in network \u2013 included in ER copay<\/span>) where it had to be scrutinized by a doctor (sorry, I can\u2019t remember his title.\u00a0 I just have his name and his bill.\u00a0 out of network \u2013 $423 <\/span>)
After 7 hours in the ER, they decided to admit her to the hospital for more testing an observation ( hospital in patient care in network $874<\/span> ).\u00a0 That night, she was seen by another orthopedist ( out of network $316<\/span> ) who confessed that he wasn\u2019t sure but that he was leaning towards calling it Rheumatoid Arthritis.\u00a0 He decided to send her file to the other Children\u2019s Hospital in town, where they have pediatric rheumatologist on staff, for another opinion.\u00a0 The rheumatologist wasn\u2019t on call that night, but 2 more orthopedists were happy to look at her films and offer their opinions. ( One consulted for free<\/span>, the other was out of network $87<\/span>)
The next morning, yet another orthopedist came to look at her ( out of network \u2013 $397<\/span> ) before calling in the head of orthopedics ( in network \u2013 included in hospital co-pay<\/span> ) <\/p><\/blockquote>\n

We weren\u2019t done yet, but you get the idea.\u00a0 Hospitalizations are not only stressful, they are a dizzying maze of people, procedures, and fear.\u00a0 In less than 24 hours, we had already amassed 16 bills totaling over $7,000.\u00a0 Before we were finished getting a diagnosis and seeing specialists, the total would be in the tens of thousands of dollars.\u00a0 While our insurance has a cap of $5,000 per family per year, that doesn\u2019t include out of network physicians or facilities.\u00a0 There is no cap, no limit at all, on our financial obligation when we go out of network.\u00a0 It sounds as if it would be a simple thing to do until you are in a hospital and the out of network physicians are not people you ever see.<\/p>\n

The insurance companies will tell you that it is the responsibility of the patient to ask questions and choose the doctors, even in the hospital, whom they wish to see.\u00a0 In practice, it is not that simple, as many of the doctors we \u201csaw\u201d that night never actually saw her.\u00a0 What do we do in real life about the in network\/ out of network farce?\u00a0 The solution for this would be so simple.\u00a0 If we, through our elected officials, were to require that all medical personnel within a hospital or medical facility accept, at minimum, all the insurances which are considered in network for that hospital or facility. This would insure that once a network in listed as being covered, it truly is.\u00a0 Additionally, all physicians in a hospital or facility should bill out through the hospital\u2019s billing office so that there is a centralized place for patients to send payments as the sheer volume of bills can quickly become overwhelming.\u00a0 One visit to the hospital should be one bill.\u00a0 That seems only logical.<\/p>\n

Until such time as this reform is made, I\u2019m now adding my own conditions to the admissions forms at hospitals and ER\u2019s.\u00a0 On the page which says I am ultimately responsible for all bills incurred, I write<\/p>\n

\u00a0\u201cWe refuse all non-emergent non-life-saving treatment by any physician or personnel who are considered \u2018out-of-network\u2019 by\u00a0 (our insurance company\u2019s name) when an \u2018in-network\u2019 alternative is available.\u00a0 Any \u2018out-of\u2019network\u2019 care which is not necessary to save life or limb will be considered to have been performed pro-bono and will be treated in that manner.\u201d\u00a0\u00a0<\/p><\/blockquote>\n

Then I sign and date it and make the person checking us in sign it, too.\u00a0 They\u2019re never happy about it, but they always sign.\u00a0 Would it hold up in a court of law?\u00a0 I don\u2019t know.\u00a0 What I do know is that since I\u2019ve been adding my own little addendum, we haven\u2019t had any more out of network charges which has dramatically lowered our health care costs.<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

Once upon a time, I thought that the way health insurance worked was simple.\u00a0 If you got sick, you found a doctor or a hospital on your list of providers and you went to them, because they were the ones in-network.\u00a0 It all seemed so simple, in theory, that I would hear tales of people […]<\/p>\n","protected":false},"author":1979,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-353","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nThe In-Network\/Out-of-Network Scam<\/title>\n<meta name=\"description\" content=\"Once upon a time, I thought that the way health insurance worked was simple.  If you got sick, you found a doctor or a hospital on your list of\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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