手术前有没有经保险pre authorization, 如果有，即使是out of network，保险公司也可能会cover。
我曾经用过imaging service, service provider 是in network, 但后来账单imaging service 处的医生另外收费是out of network。打电话给保险公司，因为有家庭医生的referral, 而且imaging service provider 是in network, 他们很快就改为 cover了。
没有保险公司的pre authorization，手术医生是OB refer的，都是in network，但医生选的手术中心是out of network。
手术前有没有经保险pre authorization, 如果有，即使是out of network，保险公司也可能会cover。 我曾经用过imaging service, service provider 是in network, 但后来账单imaging service 处的医生另外收费是out of network。打电话给保险公司，因为有家庭医生的referral, 而且imaging service provider 是in network, 他们很快就改为 cover了。
同意，绝对不正常。我生宝宝的时候，前期给保险公司打电话问这个医院可以不可以cover，我的ob可以不可以cover，induction可以不可以cover，每进来一个人我都要问你是不是in-net-work，是不是我接受的医疗和各种检查都是in-net-work，护士和医生都跟我说，no reason to worry。 结果呢，还是有一个给宝宝检查耳朵的医生charge了大几百的out-of-network。感觉无比扯淡，我生娃还是周末，那个时候即使我想打电话有力气打电话确认，我那个保险公司周末也没人理我啊……
我先是给保险公司客服打电话，客服一听就是off-shore的，要我写appeal letter 要求process as in-network寄给保险公司，通常几十天可以收到回复。后来我收到保险公司的问卷调查，我就给了个差评要求有人跟我follow up。保险公司派了专人跟进，了解情况，直接跟对方讨价还价，打折后我只要付100多块钱。而且当年我deductable已经到了，所以后来这100多块钱我也没有出。
如果你需要写信的话，可以从这几条下手：
I would like to request the claim to be processed as in-network exception for the following reasons: 1. I was treated without my knowledge or consent by the practitioner who does not participate in my health plan 2. I did not have a choice in selecting an in-network or out-of-network assistant surgeon 3. The facility where the service was rendered is in-network 4. The service was a medically necessary 5. I was not provided with an estimate of cost by the hospital beforehand, nor did I ever sign a written consent form acknowledging the services would be out-of-network and would result in costs not covered by the health plan
我先是给保险公司客服打电话，客服一听就是off-shore的，要我写appeal letter 要求process as in-network寄给保险公司，通常几十天可以收到回复。后来我收到保险公司的问卷调查，我就给了个差评要求有人跟我follow up。保险公司派了专人跟进，了解情况，直接跟对方讨价还价，打折后我只要付100多块钱。而且当年我deductable已经到了，所以后来这100多块钱我也没有出。
如果你需要写信的话，可以从这几条下手：
I would like to request the claim to be processed as in-network exception for the following reasons: 1. I was treated without my knowledge or consent by the practitioner who does not participate in my health plan 2. I did not have a choice in selecting an in-network or out-of-network assistant surgeon 3. The facility where the service was rendered is in-network 4. The service was a medically necessary 5. I was not provided with an estimate of cost by the hospital beforehand, nor did I ever sign a written consent form acknowledging the services would be out-of-network and would result in costs not covered by the health plan
我先是给保险公司客服打电话，客服一听就是off-shore的，要我写appeal letter 要求process as in-network寄给保险公司，通常几十天可以收到回复。后来我收到保险公司的问卷调查，我就给了个差评要求有人跟我follow up。保险公司派了专人跟进，了解情况，直接跟对方讨价还价，打折后我只要付100多块钱。而且当年我deductable已经到了，所以后来这100多块钱我也没有出。
如果你需要写信的话，可以从这几条下手：
I would like to request the claim to be processed as in-network exception for the following reasons: 1. I was treated without my knowledge or consent by the practitioner who does not participate in my health plan 2. I did not have a choice in selecting an in-network or out-of-network assistant surgeon 3. The facility where the service was rendered is in-network 4. The service was a medically necessary 5. I was not provided with an estimate of cost by the hospital beforehand, nor did I ever sign a written consent form acknowledging the services would be out-of-network and would result in costs not covered by the health plan
我先是给保险公司客服打电话，客服一听就是off-shore的，要我写appeal letter 要求process as in-network寄给保险公司，通常几十天可以收到回复。后来我收到保险公司的问卷调查，我就给了个差评要求有人跟我follow up。保险公司派了专人跟进，了解情况，直接跟对方讨价还价，打折后我只要付100多块钱。而且当年我deductable已经到了，所以后来这100多块钱我也没有出。
如果你需要写信的话，可以从这几条下手：
I would like to request the claim to be processed as in-network exception for the following reasons: 1. I was treated without my knowledge or consent by the practitioner who does not participate in my health plan 2. I did not have a choice in selecting an in-network or out-of-network assistant surgeon 3. The facility where the service was rendered is in-network 4. The service was a medically necessary 5. I was not provided with an estimate of cost by the hospital beforehand, nor did I ever sign a written consent form acknowledging the services would be out-of-network and would result in costs not covered by the health plan
我先是给保险公司客服打电话，客服一听就是off-shore的，要我写appeal letter 要求process as in-network寄给保险公司，通常几十天可以收到回复。后来我收到保险公司的问卷调查，我就给了个差评要求有人跟我follow up。保险公司派了专人跟进，了解情况，直接跟对方讨价还价，打折后我只要付100多块钱。而且当年我deductable已经到了，所以后来这100多块钱我也没有出。
如果你需要写信的话，可以从这几条下手：
I would like to request the claim to be processed as in-network exception for the following reasons: 1. I was treated without my knowledge or consent by the practitioner who does not participate in my health plan 2. I did not have a choice in selecting an in-network or out-of-network assistant surgeon 3. The facility where the service was rendered is in-network 4. The service was a medically necessary 5. I was not provided with an estimate of cost by the hospital beforehand, nor did I ever sign a written consent form acknowledging the services would be out-of-network and would result in costs not covered by the health plan
我先是给保险公司客服打电话，客服一听就是off-shore的，要我写appeal letter 要求process as in-network寄给保险公司，通常几十天可以收到回复。后来我收到保险公司的问卷调查，我就给了个差评要求有人跟我follow up。保险公司派了专人跟进，了解情况，直接跟对方讨价还价，打折后我只要付100多块钱。而且当年我deductable已经到了，所以后来这100多块钱我也没有出。
如果你需要写信的话，可以从这几条下手：
I would like to request the claim to be processed as in-network exception for the following reasons: 1. I was treated without my knowledge or consent by the practitioner who does not participate in my health plan 2. I did not have a choice in selecting an in-network or out-of-network assistant surgeon 3. The facility where the service was rendered is in-network 4. The service was a medically necessary 5. I was not provided with an estimate of cost by the hospital beforehand, nor did I ever sign a written consent form acknowledging the services would be out-of-network and would result in costs not covered by the health plan
我先是给保险公司客服打电话，客服一听就是off-shore的，要我写appeal letter 要求process as in-network寄给保险公司，通常几十天可以收到回复。后来我收到保险公司的问卷调查，我就给了个差评要求有人跟我follow up。保险公司派了专人跟进，了解情况，直接跟对方讨价还价，打折后我只要付100多块钱。而且当年我deductable已经到了，所以后来这100多块钱我也没有出。
如果你需要写信的话，可以从这几条下手：
I would like to request the claim to be processed as in-network exception for the following reasons: 1. I was treated without my knowledge or consent by the practitioner who does not participate in my health plan 2. I did not have a choice in selecting an in-network or out-of-network assistant surgeon 3. The facility where the service was rendered is in-network 4. The service was a medically necessary 5. I was not provided with an estimate of cost by the hospital beforehand, nor did I ever sign a written consent form acknowledging the services would be out-of-network and would result in costs not covered by the health plan
————————————————-
做了一个小手术，医生是in network，手术前跟前台确认过是不是都是in network，她们说是，还跟我说只用自付几十刀就好，今天收到保险公司的信，说out-of-network provider charge我六万多刀，保险allowance 9000，如果provider不降价，我就要付差价。请教这种情况怎么argue？前台跟我也只是当面语言确认，没有邮件，有多大可能性让他们转成in network，或是降价到保险的allowance内？
我最近也遇到类似问题，去clinic之前在保险的网站上查了是in network的。给保险公司打电话也确认了in network.
结果去了一次后 ,clinic给我打电话说他们是out of network的。他们有两个部门，一个是in network,我去的这个不是。保险公司的网站信息不确切。只把这个clinci列在innetwork下。保险公司的人也不清楚。
好在我就去了一次，大概几百块的账单吧。
有些州是有立法禁止这种操作的，建议楼主先看看是不是属于这21个州的
https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2017_jun_lucia_balance_billing_ib.pdf
☆ 发自 iPhone 华人一网 1.14.03
我曾经用过imaging service, service provider 是in network, 但后来账单imaging service 处的医生另外收费是out of network。打电话给保险公司，因为有家庭医生的referral, 而且imaging service provider 是in network, 他们很快就改为 cover了。
美国这个医疗制度, 绝对不正常好吗?
病人都需要开刀了, 还要一个个确认是不是in-net-work.
前台给的讯息还不能相信, 要自己打电话问保险公司...
通常手术医生不是需要跟保险公司预先确认拿到许可才做的吗？
的确不正常，不过新找的provider需要打电话给保险公司prior authorization这是常识吧，更何况是做手术这种天价service
保险公司接线员也层次不齐。我曾经为了确认一个医生是in network的打了七八个电话，有五个说是in network，两个说不是network，还有一个说找不到这医生。
这个我专门打电话问过保险公司。
对于out of network的医院，保险公司在计算deductibles 和maximum out of pocket的时候，只计算allowance的部分。
至于医院bill你多少。他们不管也不计算。这部分是病人的责任。
所以虽然医院bill了你6万，但是对于保险公司来说，你的deductibles 和maximum out of pocket都 只用了9000。
同意，绝对不正常。我生宝宝的时候，前期给保险公司打电话问这个医院可以不可以cover，我的ob可以不可以cover，induction可以不可以cover，每进来一个人我都要问你是不是in-net-work，是不是我接受的医疗和各种检查都是in-net-work，护士和医生都跟我说，no reason to worry。 结果呢，还是有一个给宝宝检查耳朵的医生charge了大几百的out-of-network。感觉无比扯淡，我生娃还是周末，那个时候即使我想打电话有力气打电话确认，我那个保险公司周末也没人理我啊……
和医院谈判呢一下，再交了一万五（医院拿到共两万），没能谈到fair price 12000, 也不错了
对了医疗费用过高的话，tax据说有的情况可以deduct。而且这个时候以前存的HSA也可以用上了（HSA没有年限，FSA有年限）
刚才好多MM对美国医院保险怨气极大。其实，如果一切按照规矩和保险来，美国的高科技的医疗是世界上最透明最先进的最便宜的，没有之一。以上面为例，这个顶级的医生在另外一家保险公司就是in network，你自己只要付$1600 out of pocket max即可。
没办法 这就是美国
是的，都要先和保险公司确认。
反正我收到医疗账单都是先打电话给保险公司，确定我要付的费用，然后才付账单
两边都要confirm的，如果再不cover就没法了
我也受过一次骗， 好在就骗了一副牙套而已。 黑就一个字。
真担心账单
先进不先进不谈，美国的医疗绝对是世界上最不透明最贵的
所以我坚决支持全民医疗，政府接管
---发自Huaren 官方 iOS APP
一个小手术 麻醉师不在in network 后来也是扯皮很久 麻醉师还超级贵。我当时也不可能躺床上拽着手术室的门先确认麻醉师的保险再进手术室啊。
还有过医生在系统里 送检的lab不在的
好多狗血
这是前台负责refer的人员搞错code了吧。
不过说实话，大部份诊所的前台真的是又笨又蠢，并且做事完全不认真不仔细。
救护车一次4千美元，还没有deductbale，别问我怎么知道的
那还不如单独给孩子买政府的保险，按照家庭收入收费，最高的每个月的月费也不贵，
救护车保险全部cover
☆ 发自 iPhone 华人一网 1.14.03
☆ 发自 iPhone 华人一网 1.14.03
呵呵 你是没生过病吧，不知道其中的泪。
保险公司的信你不用管，医生又没找你要钱，他们会把你那部分免掉的 ---发自Huaren 官方 iOS APP
不是大病真的出美国去现金在周边国家看都便宜，美国医疗系统太落后，太垃圾，太黑社会。
这种情况就不用再问医院了吧？我也有类似情况，生娃过程中一个70刀的疫苗，保险没有cover.孩子一岁多了ob诊所也没给我寄账单……我还想是否需要问下诊所～是不是没必要了？
这个太有用了。难怪退休那么多人去佛罗里达 ---发自Huaren 官方 iOS APP
问题是病人怎么可能搞清楚中间所有步骤都是谁，约好手术，除了主刀医生，别人都有可能换，难道发现麻醉师换人了你就不做了？
楼主你做得很好了，是系统的问题 ---发自Huaren 官方 iOS APP
我先是给保险公司客服打电话，客服一听就是off-shore的，要我写appeal letter 要求process as in-network寄给保险公司，通常几十天可以收到回复。后来我收到保险公司的问卷调查，我就给了个差评要求有人跟我follow up。保险公司派了专人跟进，了解情况，直接跟对方讨价还价，打折后我只要付100多块钱。而且当年我deductable已经到了，所以后来这100多块钱我也没有出。
如果你需要写信的话，可以从这几条下手：
I would like to request the claim to be processed as in-network exception for the following reasons:
1. I was treated without my knowledge or consent by the practitioner who does not participate in my health plan
2. I did not have a choice in selecting an in-network or out-of-network assistant surgeon
3. The facility where the service was rendered is in-network
4. The service was a medically necessary
5. I was not provided with an estimate of cost by the hospital beforehand, nor did I ever sign a written consent form acknowledging the services would be out-of-network and would result in costs not covered by the health plan
还有一个办法，如果你是公司提供的保险，问公司HR要到保险agent的联系方式，他们可能在保险公司有自己的contact，可以跳过customer service。
楼主好运！
祝好运 能有时间确认的都是不急的，你这种情况我也遇到过，没办法控制。 ---发自Huaren 官方 iOS APP
学习了，也应该早来这里发帖的。 ---发自Huaren 官方 iOS APP
你最后麻醉师部分怎么解决的？ ---发自Huaren 官方 iOS APP
一定要和保险公司的客服确认，医生和前台有时候都不准的，他们自己都不清楚。而且最好要有email的有证据的记录。保险公司的网站也不是百分百准确，我们保险公司网站上写的他们的数据库仅供参考，要和医生确认，因为有的医生变更network，保险公司数据库没有按时更新。所以一定要和保险公司的客服询问，而且打电话不够，要email留底。
不过楼主的情况，可以讲价的，美国医疗太不透明，我做的一个小手术，医院医生都是in network，最后账单医院12000，保险付了1100，医生charge 6800，保险给了900。水分及其巨大。 ---发自Huaren 官方 iOS APP
谢谢分享! 我以前也appeal过麻醉师不在in network的情况，我具体也是appeal说我对于麻醉在不在我的network我并没有选择，但是保险公司还是deny了我的appeal ---发自Huaren 官方 iOS APP
谢谢你，很有用的信息。也曾给保险公司打电话打得头痛。发现就算是电话接线的或者医院前台，搞不清楚的也是多得是。
thanks for sharing
是的，我也是单独给孩子买。几乎所有service 都 cover。就是可能医生,医院的network 不如私人保险的cover 得多，好
呵呵，当美国实现全民保健了，你到时候是不会再抱怨医疗账单，抱怨的是着急看医生的时候要等几个月。
我觉得是你的保险公司服务好吧。你看医生上手术台要签好多文件好多条款，很少人去认真读自己签的是什么的吧，自己签了consent 也不知道
re 我就碰到过，大夫说肯定收，这个保险他见了很多次了，然后保险公司说我找不到这个医生啊╮(╯_╰)╭
要换个接线员试试，还有保险公司网上一般能找到是不是in net work
mark mark mark
所以我干脆换PPO了
ppo也有out of network 啊
这个很有用!
不信这个，现在的medicare就是政府的，好像也没听说过什么要等几个月
美国人口比加拿大或欧洲小国多得多，规模效益大得多，科技也领先得多，医生原来挣50万，全民医疗后挣20万，也许会一时不爽，但时间长了就习惯了，现在挣不到20万的行业比比皆是，难道都不干活了