Tuesday, July 13, 2021

Who Needs Anesthesia?

After my last post about being grateful for having health insurance to cover my upcoming shoulder surgery, a bizarre thing happened. I got a call from the surgeon's office advising me that the anesthesia group used by the surgery center I will be going to is not in the network of my medicare supplemental plan. That means the insurance company will pay the anesthesiologist the in network rate and I will be responsible for the difference. The anesthesia group sent me a form to sign that states I understand they are out of network. So wait - the surgeon is in network and the surgery center is in network, but the anesthesia group they use is not? That doesn't make any sense to me. The woman who called me suggested I call my insurance company and double check on the anesthesia group.

When I talked to the representative at the insurance company, on a phone call that lasted a total of 1 hour and 25 minutes, she advised me that there are no anesthesiologists within 100 miles of where I live who are in network. I should mention that I am in one of the largest medicare supplemental plans in the U.S., and I live in a metropolitan area with a population of 2.6 million people. How is this even possible? I told her it makes it pretty difficult to have surgery when they don't have any anesthesia groups in the plan. She put me on and off hold listening to the same craptastic song over and over while she was checking with various supervisors. The end result was being told that my case was being taken under review, and I would hear in two weeks whether they would consider the anesthesia to be in network or not.

In the meantime I called the broker who sold me the plan to let her know what was going on. She has over 600 medicare clients, and she has never heard of such a thing. She told me she would go further up the ladder in the insurance company than I did, and would have an answer for me within a couple days. Sure enough, two days later she called to tell me what she learned. Apparently this insurance company has a contract with the surgery center where they cover everything that happens at the surgery center under one payment to the center. Since anesthesia falls under that, it will be covered as being in network. Because she knows what she is doing, she got this in writing.

A few days ago a different person from my insurance plan called me asking for the anesthesia code. I have no idea how they will code this procedure, and they probably don't either at this point. So obviously I am still "under review" by the insurance company. I'm sure I haven't heard the end of this yet.

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