I’m a 20-year-old college student who had wrist surgery back in December 2024. A PA gave me the choice of local anesthesia or full anesthesia, and when I asked if both were covered, he said yes. He recommended full anesthesia for my surgery since it was pretty invasive. My insurance (Blue Cross) covered the surgery with a copay, but now I got a surprise bill for $2500 just for the anesthesia. I’m a full-time student barely scraping by, and I don’t know how to handle this bill. Has anyone successfully appealed or managed to reduce a bill like this? Should I apply for Medicaid or something? I’m in California, by the way. Any help would be appreciated.
Did your insurance get billed? My daughter had surgery recently, and the anesthesiologist didn’t bill my insurance at first and just assumed I’d pay out of pocket.
Avery said:
Did your insurance get billed? My daughter had surgery recently, and the anesthesiologist didn’t bill my insurance at first and just assumed I’d pay out of pocket.
They did bill my insurance, but they told me the anesthesiologist was out of network… I submitted an appeal already.
@Randy
Being out of network doesn’t mean you’re completely responsible for the costs. The anesthesiologist can submit their billing, and insurance might cover it, depending on your plan. When I had my wrist surgery, even though the anesthesiologist was out of network, my insurance covered it completely after I met my deductible and out-of-pocket max. Have you received your EOB from all providers yet? It sometimes takes a bit for everything to come in. Make sure to double-check your plan’s coverage details for your appeal.
@Hadi
Anesthesiologists being out of network is pretty common. A lot of emergency department doctors are in the same boat. You usually don’t get a say in who provides anesthesia, which is why they can charge what they want. Fight back, and make sure to let your doctor and the surgery facility know. I had a procedure done recently and complained about the lack of an estimate on the anesthesia cost, and it helped address the issue.
@Randy
Is this amount based on the EOB from Blue Cross or from the anesthesiology billing office itself? Check out the No Surprise Act. Under this act, anesthesia claims should be handled as if they were in network, reducing your responsibility to what you’d owe if they were in network, and protecting you from surprise bills. Make sure it’s billed correctly to your insurance and review your EOB.
@Randy
Was there no estimate given to you before the procedure? If that’s the case, maybe the No Surprise Act applies here. You might want to check my profile for my post on anesthesia and insurance; the comments there are also helpful!
How does a PA know what your insurance will cover anyway?
Bly said:
How does a PA know what your insurance will cover anyway?
I realize I should have checked the coverage myself… I’m not blaming him for it; I’m just looking for some advice here.
@Randy
It’s understandable; you were dealing with a lot at the time. What kind of surgery did you have?
@Randy
Honestly, don’t pay them if you don’t have to. As a college student, it’s not like you’re going to jail for refusing payment. Worst case, they might sue for the money later. Also, there’s talk that laws will start changing soon regarding medical debt on credit reports, so it may not even impact your credit. Just check your EOB and see if any protections from the No Surprise Act apply before considering payment. Don’t pay just because a bill arrives.
@Sam
Stop encouraging people to ignore their bills. It’s really not right to say that. Trying to justify why someone shouldn’t pay is not the solution here.
Vero said:
@Sam
Stop encouraging people to ignore their bills. It’s really not right to say that. Trying to justify why someone shouldn’t pay is not the solution here.
Those anesthesiologists really are scamming patients. This isn’t the first time I’ve heard complaints about this.
Vero said:
@Sam
Stop encouraging people to ignore their bills. It’s really not right to say that. Trying to justify why someone shouldn’t pay is not the solution here.
Look, our healthcare system itself is pretty messed up. The idea of refusing to pay these huge bills is justified. The prices are insane, and folks usually have no clue what they might owe until later. It’s crazy that you have to be a lawyer just to figure it all out. I’m okay with telling people to stand their ground and not pay when it’s unjust.
@Sam
There’s nothing scammy about this; it’s just complicated. Yeah, reading through policies can take time, but you can understand what’s covered and what isn’t. By telling people not to pay, you’re just adding to the confusion instead of helping folks actually navigate the situation. If people avoid paying their bills, costs will just go up for everyone else too. You can be part of the problem while complaining about the system.
I went through something similar last year. The anesthesiologist billed separately, but since I’d met my deductible, my fees ended up being much lower. Definitely explain to your insurance company that you didn’t choose the anesthesiologist.
This seems to happen quite often. I had surgery on my leg last year, and everyone involved was in-network except for the anesthesiologist. They went through my old insurance info instead of the current one I provided. Three months after the surgery, I got a bill for thousands. I called them and explained they needed to bill my current insurance, or I’d consider legal action.
As long as the hospital and your doctor were in-network, you don’t really have a say in who gives you anesthesia or performs radiology reports. Your insurance company has to pay for those services.
Usually, Blue Cross will cover out-of-network anesthesiologists if your physician was in-network after an appeal. They may work with you to reach an agreement.
Hey there! Every insurance plan is a bit different, but generally, there’s something called the “ologist” rule. This means that the OONPAI rule (out of network pay as in) may apply. Even though the anesthesiologist is out-of-network, the claim should process with in-network benefits. You might still get a balance bill for what your plan doesn’t cover though. Call your insurance and get the EOB for this claim. You might want to ask the provider to adjust the bill based on your EOB. I work in health insurance, so feel free to ask if you have questions. I can offer insight where needed.
Edit: Some people are mentioning the NSA, and yes, that should protect you from balance billing, so check your EOB and see what your patient responsibility is listed there.