Can i do anything about my health insurance?(pregnant)?

Question

I am 27 weeks pregnant, i have blue cross blushield solutions and it has covered all my Dr's visits, my Dr sent me to get an ultrasound at a different floor in the hospital (which is listed on my insurance) i now have a bill from them, it says the insurance wont cover because its out of network the bill is not coming from the hospital is coming from the technitians. Can i appeal this or something, I've never had insurance before please help me.

Answer 1

Call the insurance company. They should be able to help you. It depends on your plan. There should be a number on the card. Either that or the hospital used the wrong code to bill the insurance therefore that could be causing the issue -the hospital may have to re-code and re-submit to the insurance but, it depends on the type of insurance plan you have. The first step is to call the insurance company then call the number on the bill.

Good Luck

Answer 2

Yes, you definately want to appeal it with your insurer.  They make mistakes.  Sometimes, a LOT of mistakes.  

If the hospital is in network, the "out of network" technician that works there, needs to be paid as if they are in network.  But you'll need to do the appeal thing to make it happen.

Don't let it go - follow up on it.

Answer 3

Unfortunately when you're in a hospital even though the hospital may be in network you may be seen by doctors or physicians that aren't.  Whenever I end up in an emergency room I always write on the admittance forms that I want to be seen by in network physicians only.

In your case I'd argue that they should have told you since they have your insurance information.  I'd pay what I would have owed if they were in network.

Answer 4

chances are the radiologist are independent contractors who work for the hospital.  

Call your insurance company and tell them that you were at an in network facility, having a test that your in-network doctor ordered.  Usually an insurance company will process those claims at an in-network level.  However, the insurance company will not pay charges above usual and customary.  So, while BCBS will pay the claim like it would normally, BCBS will still discount the procedure like it was in network, the provider usually won't except this lower amount and you will be stuck owing that.

Answer 5

Call the ultrasound area and have them check the charges.  It's possible that the claim was coded incorrectly and they can correct it with the insurance carrier.  If that doesn't work, speak with your doctor's office for their assistance and also talk with the carrier directly.  It seems that an ultrasound on a pregnant woman should be covered.