My story is below. My two questions are listed at the end of the last paragraph. NOTE: This is my first experience with surgery of any kind.
In January, 2012' I underwent micro surgery on my L4/L5 disc for relief of severe Sciatica. The surgeon I selected was referred by a local Orthopedic Dr and was considered "in network" by my ins carrier. I also made certain he was pre approved by the ins co (in writing) to avoid medical bills later. However, two days before surgery i received a call from his office regarding the pre-op exam as well as informed by the receptionist that my surgeon was was"out of Network". The following morning I called my ins company in a panic and was informed that his "in network" provider I.D. number was still on file with the ins co (which he was approved under) and that I should not worry about payment.
The morning of my surgery (7:30am), I met with the surgery center admin Clerk who explained to my finance and I that the surgery center (my surgeon selected) was "out of network, but would accept what my insurance company paid them and not bill me. When I received the EOB it stated the center billed for $44k and received $22k. To date, I have not received any add'l bills from the center and hope not to.
After finishing up with the admin clerk, I waited another 20 min before being called into the prep area to change into a hospital gown & cap and lay on a rolling bed. At approx 8:15am, I was informed by the prep area nurse that the surgery would be delayed for 30 min for cleaning of the O R. During the wait, three unknown medical personnel approached me at bedside (about 3 minutes apart), briefly introduced themselves and handed me clip board forms to sign. Assuming they were part of my surgeon's personal staff (paid by him) I greeted them as my saviors to my severe back pain,quickly signed the forms without question or clearly reading and handed them back. The first woman informed me she would be monitoring my vital signs, a second young man said he was the anesthesiologist and a third young man said he was the assist surgeon. Minutes after they walked away my surgeon walked up to the bed in his winter coat and said "are you ready to go!!" and five minutes later I was rolled into the O R. The surgery lasted approx. 30 min, I rested for 15 min and was released to return home.
Approximately 30 days after surgery, I received a bill in the mail for $20,116.00 from a company representing the Asst. Surgeon. When I contacted them I said, I don't understand why you are billing me due to the fact my surgeon was in network and he was the person that secured your service, not I. (I would have secured an "in network" Assistant for cost reasons as I did with the lead surgeon). The following morning I contacted the ins co confused/concerned and was informed that the asst's claim was paid $116.00 and the remainder due ($20k) was my responsibility. They also said that the asst's claim was submitted under the same procedure codes as the lead surgeon and they do not pay two parties for the same procedure(s). My question is: is this case considered in any way "wrongful practice" ? How I was surprisingly approached at bedside (in pain) to sign payment consent forms only minutes before my surgery? My second question is: what if I had refused to sign any forms that morning, would my surgery have been canceled on the spot?
I appreciate your response on any pro's or con's.