Question
Hello... Recent knee surgery. BC/BS of IL PPO. My medical provider, a local outpatient surgery center, made a point of making me wait to have the surgery until they determined that it was "authorized" by BC/BS. The medical providers web site says that they participate in the BC/BS PPO managed care program. Later after the surgery was complete and I received my statement of benefits from BC/BS, it said that the provider was out of network - non PPO. This seems to be in direct opposition to what the provider's website claims and to the fact that I was told the procedure had been approved by BC/BS. Out of network charges were $10000 with BC/BS paying only $600. When I called, BC/BS said that the provider was indeed non-PPO and that the provider should have told me but that there was nothing they (BC/BS) could do about it. The surgery center said that the doctors/nurses, etc were PPO but that the surgery center itself was not. Again, in opposition to what I was made to believe before the procedure. Any recourse?
Answer
Hi Todd!
I would call the surgery center and tell them that they "lied" to you since you waited to have the surgery to ensure that you had authorization. Tell them you feel they were not honest by not telling you the truth. Therefore you refuse to pay any of this bill beyond what would have been your responsibility if in network.
If they refuse tell them that you will contact the BBB, insurance commissioner, governor and the local news. See if that works------usually does.
Providers should always be honest and advise patients accurately so they can make good decisions for themselves. When providers lie you were not given the opportunity to find another provider in your network.
Good Luck.
Tricia
