Being charged out of network, after our pediatric surgeons and unit was removed from hospital, and we were promised that if our kids were transferred to other hospital or doctors it would be covered in network.
I live in Idaho and we have two main hospitals: st Luke’s and St Alphonsus. I am a nurse that works for St Alphonsus. A couple years ago, our hospital got rid of all of our pediatric surgeons and pediatric hospital unit. We still have pediatricians but if anything that’s significant, will be referred to st Luke’s. We had a huge meeting with HR and said that us nurses were considering quitting and moving to the other hospital because basically our kids wouldn’t be covered. They told us in that meeting, that any kids needing extra care and are transferred to St Luke’s it would be covered in network because our facility doesn’t have the means to treat them.
So last November my daughter’s neck started to swell, we went to our pediatrician that immediately referred us to a same day appointment to st Luke’s, and they thought it was lymph node cancer. We urgently did Ultrasounds, X-rays, labs trying to rule out all the possibilities. We then got scheduled for neck surgery to remove her lymph nodes so we could test them for cancer. Pathology came back non cancerous and they sent the tissue to Seattle to see what was causing it. They just did this, not ever giving us options etc.
So we got billed out of network… I’ve been fighting this since December 2023. Eventually we got the providers “in network” but all their orders, labs, X-rays, ultrasounds, surgery and recovery, are all billed out of network. Our in network out of pocket max is 5000, but our out of pocket max is 10,000… I feel like I’m getting the ring around and don’t know how to fight this. Do I talk to my hospital advocates, billing, HR… I’ve tried talking to Aetna… do I contact st Luke’s billing…I’ve talked to all three of them but keep getting told to talk to “someone else”… it’s been a year and it’s all mushing together in my pain (pregnancy brain). How do I fight this?