Penalty for emergency surgery at a non-HCA facility?
My husband had an injury to both of his hands which required emergency surgery. He was seen in the ER the same day, given an urgent referral to a hand surgeon who saw him the next day, and taken immediately to the OR. He had staged surgeries over multiple days- all outpatient with no hospital admission. The hand surgeon thoroughly documented that his condition was emergent and a medical emergency per our state's administrative code.
We have Aetna through my husband's job, which is at an HCA hospital. The hand surgeon was in-network, as was the hospital. However, because the hospital was only in-network and not specifically an HCA facility, they're charging us massive penalties based on failure to precertify and not using an HCA facility. However, since the hospital is in-network, we weren't supposed to have to pre-certify at all.
Since it's not an out-of-network provider, all the no surprise act stuff doesn't seem to apply and I'm struggling to find information about our grounds to appeal. Input is appreciated.