Man charged out of network fee at in network hospital

Updated: Oct. 27, 2020 at 9:48 AM EDT
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HICKORY, N.C. (WBTV) - Imagine having a medical emergency, going to your in network hospital for care, and then months later, being blindsided by a bill for more than $1,500 that you were told was covered by insurance.

That’s exactly what happened to one of our viewers, who saw a similar WBTV Investigates report and decided to call WBTV for help.

Todd Meixner went to Catawba Valley Medical Center for surgery in July. He went to that hospital because it was in network with his insurance, UnitedHealthcare. Meixner had already met his deductible, so he was stunned to see a bill from Western Piedmont Anesthesia for $1,517.

“There was no other anesthesia there at all besides the Western Piedmont and that’s who they normally carry, but they’re an out of network,” said Meixner.

Before his surgery, Meixner says he was never told his anesthesiologist would be out of network and there was no other provider at the hospital, so he wasn’t given any other choice but to go with Western Piedmont Anesthesia.

“When I went and spoke with a nurse, I told them I have UnitedHealthcare. ‘Do you guys accept UnitedHealthcare?’ and they told me, ‘Yes we do,’ and that ‘you should be fine.’”

Meixner says originally the anesthesia bill was $1,668. UnitedHealthcare paid $122 and he was left to cover the difference of roughly $1,500. But why?

WBTV contacted Catawba Valley Medical Center to find out why they used an out of network anesthesia provider.

A spokesperson for the Catawba Valley Health System says, “Western Piedmont Anesthesia providers are not Catawba Valley Medical Center employees but they are credentialed to provide anesthesia services.”

Western Piedmont’s attorney David Chilman responded by pointing to North Carolina insurance law which indicates, “a health insurance company cannot penalize or subject an insured to out-of-network benefit levels unless contracting health care providers able to meet the health needs of the insured are reasonably available to the insured without unreasonable delay.”

He also says, “WPA does not have a provider contract with United Healthcare. Therefore, it is clear that contracting anesthesia providers were not reasonably available to Mr. M when he received surgery at the hospital.”

Chilman believes UnitedHealthcare should pay the total bill that Meixner received.

UnitedHealthcare says their members should expect that when they seek care through doctors and care facilities in their network that they will not receive unexpected bills from out of network anesthesiologists or other care providers. If so, I asked UnitedHealthcare why was Meixner billed for out of network when he went to an in network hospital for anesthesia services?

UnitedHealthcare says, “We have made numerous attempts over the last several years to bring Western Piedmont Anesthesia into our network at market-competitive rates that would ensure our members have access to quality, affordable care.”

That means the bill for anesthesia is the patient’s responsibility. WBTV asked North Carolina Insurance Commissioner Mike Causey if it’s fair for consumers, after surgery, to be told part of their procedure is not in network, so not covered.

“Consumers need to know what’s covered and what’s not covered so they won’t get any surprises like this,” said Causey.

WBTV asked the Commissioner specifically about Meixner’s case and to see if there are other similar cases involving UnitedHealthcare.

Causey said, “Our office is involved right now legally so I can’t comment on any of the specifics but I am well aware of that problem where patients think they’re in network to later find out they’re not in network.”

After our calls to the Department of Insurance and after speaking with the anesthesiology group, UnitedHealthcare has now agreed to adjust Meixner’s bill. His total responsibility would drop to $95.84. That’s a savings of over $1500.

“It’s a blessing believe me,” said Meixner. "I’m hard to walk and stuff like that and then you’re incurring bills that you can’t come up with and knowing it’s just a relief off my back - I just say, thank you.

The remaining question - what about previous or future patients? Officials say make sure to verify that your hospital and insurance provider are using an in network provider. Otherwise, you may end up picking up the bill.

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