u/MuffinDude

Hey all. I am back with more questions.

I made a previous post about my wife's OON ER visit, which can be found here. TLDR summary: wife had a hemorrhagic stroke, we went to OON ER where she got a emergency surgery and stayed in the hospital for couple more days until she was transferred to INN for acute therapy. EOB sent by insurance said patient responsibility is several tens of thousands of dollars. She has Blue Shield of California through her employer.

Since then, I had more chats with BCBS because we had received more EOB of different procedures and there I found out it was provider billing us the "disallowed" amount. By my understanding, this is balanced billing where the hospital bills us the portion that the insurance doesn't approve. The BCBS representative at first told me that they can't do anything about this "disallowed" portion of the bill, but when I pressed on the fact that No Surprises Act shouldn't allow the provider to bill me this amount during emergency situations, the representative looked into it a bit more and agreed that they shouldn't be able bill me this amount. My question is, in this case, is filing a dispute with BCBS enough or should I start disputing with the provider about this billing? What are some other things (like requesting itemized billing from the hospital) should I be doing to fight this?

Many thanks in advance.

Edit, change provider -> insurance for accuracy

My wife had a medical condition at the beginning of April and I took her to the nearest ER, which is out-of-network because at that point I just needed someone to examine her. There, she was diagnosed with a hemorrhagic stroke. The neurosurgeon present said it was a lot of bleeding in the brain and he heavily recommended us to get a surgery to removed as much blood from the brain as possible so we opted to do that. The surgery happened the same night as the ER visit and then she was admitted to the ICU afterwards. We recently got our Explanation of Benefits from our provider and while the ER visit was counted as in-network, the surgery itself was billed as surgery and not as ER. As a result, the patient responsibility of anesthesia and surgery totaled to about $23,000. By my understanding, No Surprises Act should cover surgeries performed during the ER visit. I have just filed a dispute of these charges and contacted the social worker of the hospital which the ER visit was done at to try to get additional documents supporting my case. In the meantime, if I can get more information on what I should be doing and looking out for, that will be extremely helpful. Thank you in advance.

Update: Her insurance is through her employer and is Blue Shield of California.