Help! Advice needed

[KMT]

Hi All, I need some advice about an insurance issue.
I'll try to make this as short as possible.
My primary care physician sends me to a sleep specialist/doctor at an affiliated hospital that is a network provider for Cigna. That specialist/doctor sends me to a sleep study within his hospital that is covered by my insurance.(Cigna covered the full amount of $2700 for the study) A week later I have another visit with the specialist/doctor to discuss the results and he wants to send me for the titration study. His assistant, that does all the scheduling, says they are sending me to another sleep clinic that will be more convenient for me and is also in my Cigna network. (so far no issues, Cigna has covered everything)
So I go forward with the titration study at the clinic they send me to.
Fast forward 2 months and I get a statement from my insurance.
Cigna was billed $5775 by the clinic of which they covered $838.03, the balance of $4936.97 is my responsibility because that clinic was out of network!
OMG... I laid awake last night with severe anxiety... I don't have that kind of money and I would have never gone to that clinic had I known they were out of network.
I think the specialists assistant completely screwed up and sent me to the wrong clinic..(I found out there are 2 within the same complex and only one of them is in my network)
I am not sure what to do now.. Anyone have any advice? Am I responsible for their screw up?

[momof2inmn]

Unfortunately, it is the responsibility of the insured to make sure that they are seeing providers who are in their network.

You can try to talk to everyone involved - ins. co., sleep clinic and sleep doc to see what might be done about it, but unless you have a sleep doc who is so honest that they are willing to cover the mistakes of their staff I think the best you can hope for is a reduction in the fees from the sleep clinic to try to make it be an amount that they have a chance of collecting.

You could also check into grants in your area. I know if you have a hospitilization that you are unable to pay for there are often grants that the hospitals have set up so that care is paid for but I don't know if that would apply with your sleep clinic.

I wish I had better news for you, maybe a miracle will happen for you but you should be prepared in case it doesn't.

[Wulfman]

Hi All, I need some advice about an insurance issue.
I'll try to make this as short as possible.
My primary care physician sends me to a sleep specialist/doctor at an affiliated hospital that is a network provider for Cigna. That specialist/doctor sends me to a sleep study within his hospital that is covered by my insurance.(Cigna covered the full amount of $2700 for the study) A week later I have another visit with the specialist/doctor to discuss the results and he wants to send me for the titration study. His assistant, that does all the scheduling, says they are sending me to another sleep clinic that will be more convenient for me and is also in my Cigna network. (so far no issues, Cigna has covered everything)
So I go forward with the titration study at the clinic they send me to.
Fast forward 2 months and I get a statement from my insurance.
Cigna was billed $5775 by the clinic of which they covered $838.03, the balance of $4936.97 is my responsibility because that clinic was out of network!
OMG... I laid awake last night with severe anxiety... I don't have that kind of money and I would have never gone to that clinic had I known they were out of network.
I think the specialists assistant completely screwed up and sent me to the wrong clinic..(I found out there are 2 within the same complex and only one of them is in my network)
I am not sure what to do now.. Anyone have any advice? Am I responsible for their screw up?

As a general "rule of thumb", you're supposed to be contacting your insurance provider for pre-approval on most of these procedures......partially to give everybody a "heads-up" and to verify the in or out-of-network status. Even if this place was out-of-network, I would think that the coverage would have been higher than that.......maybe like 40 - 60%.
If you haven't been yet......I'd strongly suggest that you get on the phone with Cigna and find out what your next move should be to get that amount whittled down. You may also want to contact the sleep lab to see if they'll drastically reduce the amount.
The part where they decided to send you to another sleep clinic seems suspicious to me. Without knowing the details of "WHY" that occurred is something that you need to discuss with Cigna, too.

I'm afraid I don't have much good news for you.
Good luck.


Den

[KMT]

Thank you for the responses.. I just heard back from the doctor's and apparently the sleep lab had received prior authorization but had not written down the authorization#, just the initials of the person at Cigna that authorized it.. seriously??
and then they did not file the claim correctly with Cigna so Cigna classified it as out of network.
It is being sorted out now and they said I am 100% covered.. Thank goodness!

[chunkyfrog]

If you're a wheel that needs greasing--SQUEAK!

[Madalot]

Thank you for the responses.. I just heard back from the doctor's and apparently the sleep lab had received prior authorization but had not written down the authorization#, just the initials of the person at Cigna that authorized it.. seriously??
and then they did not file the claim correctly with Cigna so Cigna classified it as out of network.
It is being sorted out now and they said I am 100% covered.. Thank goodness!

Congratulations on getting this sorted out. I know that's a huge relief for you.

I had a situation years ago where a doctor was in network, but the lab he used (his lab that he owned) was out of network for most insurances. He did it on purpose -- very underhanded. Because of the nature of the lab work, I HAD to use the lab that he wanted used and because he was in network, it was assumed that his lab would be too. When I got a bill from the lab saying that none of the work was covered, I had a FIT and filed a complaint with the insurance company and the doctor. No matter what argument they tried to feed me about how I should have made sure the lab was in network, yadda yadda yadda, I was able to counter it with a reason why it wasn't my fault or responsibility. I guess the lab had never had someone as determined and tenacious as I was dispute it.

They wrote it off and funny, from then on, his lab was in network. Go figure.

[elena88]

OMG, youre lucky you didnt have a heart attack when you got that bill!

Im so glad you got it sorted out!


My sleep study was also not covered (different reason, high deductable) however, I called them to ask if they gave cash discounts..
guess what? they did! If you paid cash within two weeks of the study they cut the price in half!

I told my sleep doctor this, and by the way, her office is in the hospital with the sleep center and they are all affiliated.. and
she did not know they gave discounts!

Now she does, so she tells all her patients.

I can tell you how hard it is to sleep when you KNow you are being charged a few thousand bucks for a few hours of shuteye.
Thank goodness you didnt know while you were taking the study