BCBS Claim Out of Network Due to Contract Negotiations

Hello,

I was diagnosed with testicular cancer in September 2023. I had a follow up CT scan in December 2023 which showed two enlarged lymph nodes in my abdomen, and my oncologist wanted to do a biopsy to verify how many rounds of chemotherapy I would need. The plan was that if the nodes were cancerous, I would do three round of chemo versus the planned one round (adjuvant therapy).

I had a biopsy done on 01/11/2024 at a hospital called Chandler Regional Medical Center. My insurance (BCBS) approved the surgery and the claim was marked as in network (I double checked this hospital was in network at the time). Unfortunately, the biopsy came out inconclusive because not enough tissue was gathered, so my oncologist scheduled a laparoscopic biopsy at the same hospital (Chandler Regional Medical). At this point (mid-January) I had started my first round of chemo, so there was some urgency to get the second biopsy done since it would impact my treatment plan. The surgical oncologist's office reached out and I was originally scheduled to have the second biopsy done on January 26th, but BCBS failed to approve the surgery in time. It took a few more days, but everything finally got approved (in the month of January) and my second biopsy was scheduled for February 1st.

Three rounds of chemo later, I see that the claim for my second biopsy was marked as out of network (reason code 838 the doctor/facility is not in your network). Turns out that BCBS was in contract negotiations with Chandler Regional Medical/Dignity Health and their contract at the time lapsed starting February 1st. I didn't receive any type of communication from BCBS about the contract negotiations or potential lapse of coverage, nor did Chandler Regional Medical staff mention that my surgery was out of network when I checked in the day of. BCBS is now saying that I owe the hospital ~$100,000. I tried to appeal, but BCBS just got back to me saying that they are upholding their original decision that the claim is out of network. BCBS has since renewed their contract with the hospital in March so Chandler Regional Medical is back to being considered in network.

The letter from BCBS says I can file a second voluntary appeal or ask for a voluntary external review by an Independent Review Organization. I'm honestly just so confused, and worried that even though I'm beating the cancer, I'll be financially ruined. Any advice for next steps here?

submitted by /u/Natural-Amphibian98
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