Office Thought Provider was In Network but she was Out of Network
I developed an umbilical hernia while pregnant and was referred to the local large hospital system via my PCP. They are in network with my insurance. The hospital system scheduled me a consult appt at their ambulatory surgical center. As is my habit since I’m a provider myself, I called to make sure it would be in network and they confirmed it was. I also did the early check-in via MyChart, which confirmed my insurance info and said I had a copay for the specialist visit (as an aside, I have $0 coverage for out of network providers). I signed the no surprise billing paperwork at this time as well.
Fast forward to after the visit and two claims are sent- the hospital facility claim and the provider claim. The hospital facility claim goes toward my deductible and I pay it ($297 lol), but the provider claim is denied as out of network. This was in March. I’ve spent months back and forth with my insurance (who has actually been surprisingly helpful) and the hospital billing department. Basically, it looks like they made a mistake and didn’t realize this provider’s network affiliation had accidentally either lapsed or not started (I get different answers)- she was in network officially 3 days AFTER my appointment. My insurance company is adamant I should not have to pay the balance, but the hospital says I absolutely owe it.
The billed amount for the surgeon’s claim was $487. My copay was $90, so they’re trying to collect another $397. My EOB from the insurance company shows that if the provider had been in network, the allowed amount was only $127 total. I offered to pay the $37 my insurance would have paid, but the hospital said no. I’ve appealed twice and am waiting on my second result, but I’m so frustrated. I absolutely would not have seen this provider if I’d known they were out of network. This entire facility shows as in network online, and the hospital (incorrectly) confirmed she was in network prior to the appointment. They even collected the in network copay, as stated above. Do I have any recourse?