I recently had a colonoscopy and endoscopy at 29 years old. Living in NYC, I have CIGNA Platinum PPO through my job. After dealing with irregular bowel movements, persistent dry heaving, and general stomach discomfort for over a month, I decided to see a gastroenterologist at a specialty clinic that accepts my insurance. Following an examination, the doctor recommended I have both procedures done at a different clinic he works with and mentioned Propofol would be used for the anesthesia, assuring me the procedure would be quick and painless.
After the procedures, everything seemed fine. But later that night, I received a shocking email from CIGNA regarding my claims, revealing a $17,000 charge for the endoscopy and colonoscopy, plus an additional $11,000 for anesthesia. I was in disbelief! I cannot manage a $28,000 medical bill. The claims stated it’s not covered because the provider is out-of-network, despite the fact that I confirmed the doctor and anesthesiologist accept my insurance. Feeling confused and scared, I’m here now, looking for advice and support as I get ready to call them tomorrow to resolve this. Could this be a mistake?
Have you talked directly with your insurance provider? Sometimes they have various networks, and doctors may not always know which ones they belong to.
It’s key to understand that just because a provider accepts your insurance doesn’t mean they’re in network. Providers often have different agreements depending on location.
Could this be a mistake? It’s possible. Check your Cigna portal for the provider details. If they aren’t in network, you might want to negotiate a cash price with them.
It’s not advisable to ask medical staff if they accept your insurance; that’s not their job. Make sure your plan allows you to see a specialist directly. You might require pre-authorization for these procedures as well.
@Arie
Don’t put blame on the person who posted. The system is incredibly difficult to understand. It often seems like they’re trying to get away with not covering what they should. Our system has many flaws, and patients shouldn’t be held accountable for this confusion.
@Teagan
Are you suggesting you don’t have a medical background? Just so you know, what you shared is accurate. Ultimately, patients have the responsibility here. Many places help where they can, but it’s not feasible for them to remember all the details from all plans.
@Palmer
You’re spot on. It clearly states on the back of your card that it’s the PATIENT’S responsibility to ensure they use in-network providers and obtain any necessary authorizations. This has been done as a courtesy for far too long and many patients end up unaware of their own responsibilities.
@Palmer
You’re making assumptions without knowing my medical history, which isn’t pertinent here. I’m seasoned and have seen issues around your concerns firsthand. It’s frustrating that the system avoids accountability, leaving patients blindsided.
Palmer said: @Teagan
I know age doesn’t matter here, but I respect your experience.
Sure, it’s nice to hear that, yet it’s worth noting that people are confused over how the system operates and the burden shouldn’t lie solely with patients… Providers seem to act as if it’s not their responsibility either.
@Teagan
Could it be that the doctor and facility have different networks? Understand that they can bill separately, which adds a layer of confusion for patients.
It’s crucial to note that just saying they accept your insurance isn’t sufficient. In-network status is what matters. Many dental offices often trick patients with similar language.