November 2015, I had a procedure done at West Georgia Medical Center. I made sure my doctor and the hospital were both in network with my insurance company.
I began getting billed by out-of-network providers. This meant high out-of-network co-pays. After making phone calls to these unknown providers, and dozens of calls to WGMC, I was informed by the hospital they have several contracted providers.
These providers may not be in network with a patient’s insurance company even though the hospital may be. This really upset me.
After I did my job and made sure the medical facility and my doctor were both in network with my insurance, the hospital, without my knowledge, used contracted help — radiology — that aren’t part of my PPO.
The hospital tells me to contact these out-of-network providers. So I did. I told them I was getting stuck with extremely high out-of-network co-pays because they were not part of my PPO. And, would they please re-submit the bill under the hospital’s umbrella.
The provider told me that they were contracted by WGMC to perform a procedure and I was responsible for their bill. They would not re-submit the claim. This upset me more.
I thought the hospital would be doing my procedure. Not some company I knew nothing about. If the hospital had done my procedure I would not owe anything.
I contacted WGMC again. This time they told me they are not responsible for how these providers bill the patient. Well, I say they should be.
They contracted with these people. I didn’t. I did my job. I made sure the hospital was in my network. But what I am discovering is there seems to be more contracted work at WGMC than actual WGMC employees.
So, what is a patient supposed to do? How do we know who is and who isn’t employed by the hospital? Even the emergency room physicians are contracted help. But you don’t get stuck with high out-of-network co-pays by them. You are covered because the hospital is in network. What’s the difference?
Also, before you pay your bill, you need to ask for a completed charge description with charge numbers for your procedure. I have discovered through this fiasco that contracted providers may be double dipping the patient.
The hospital doesn’t bill for these contracted providers. And they don’t seem to care how these providers bill the patient just as long as the hospital gets its share.
It seems as though if a provider at WGMC just stick their head in a patient’s room, the patient is going to get billed for something. You really have no where to turn when you get caught in this red tape.
I hope I never have to go to WGMC again. But if I do, you can bet I will ask for a list of all contracted providers. And I will sign next to my name; NO OUT-OF-NETWORK PROVIDER MAY PERFORM ANY PROCEDURE FOR ME. WILL NOT BE RESPONSIBLE FOR THEIR PAYMENT.
Debbie Chipman Reese
Editor’s note: We asked West Georgia Health to confirm their practice with contracted physicians. Their public relations department gave the following response:
“Our contracts with physician providers encourage, but don’t require, their participation in all the managed care plans with whom West Georgia Health participates. Our contract physicians negotiate their own contracts independently of West Georgia Health. Sometimes our contract physicians cannot reach a mutually beneficial agreement with a managed care company, and they decline participation in that plan. When that happens, the contract physicians may accept the payment received from the patient’s insurance without charging out-of-network penalties to the patient, but they are not obligated to do so.”