When can you fight an out-of-network provider bill?

When can you fight an out-of-network provider bill?
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#1

My mother was an inpatient in a hospital with pneumonia. She needed a test. They didn’t have the piece of test equipment and transported her to their sister hospital for the test. Turns out they use an out-of-network EMS provider. There isn’t apparently an in-network transporter. They have no incentive to ask insurance for a waiver as they do this all day long and collect from the patients instead of the insurance. Do I have any recourse or grounds for appeal/grievance with the insurance company.


#2

This is a great question!!
I would first contact the patient advocate at the hospital to see if she can get this bill waived. If she can not you will want to appeal this with your insurance company. This should be paid at the in-network rate if in fact your mother was at an in-network hospital who made the arrangements.
You will have to fight this to get this overturned and yes it’s a hassle but well worth it since ambulance fees are not cheap.
If you need assistance reach out to a medical bill advocate who can assist you.
Best of luck to you!
Cheryl Welch, MBA
Hudson Valley Medical Bill Advocate


#3

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