Doctor Sent me Out-of-Network!

I'm a 57-year-old man living in Illinois and covered by BlueCross/BlueShield HMO through a partnership with VillageMD. Upon my primary care physician's recommendation, I sought a colonoscopy. I received a list of in-network doctors from VillageMD via email, selected one, and had my doctor fax a referral with my VillageMD network details. I presented my insurance card, indicating BlueCross/BlueShield HMO/VillageMD, prior to meeting the doctor. Post-consultation, I spoke with the scheduler, who assured me they'd handle everything going forward.

However, three months later, I received a claim denial citing "Out of Network" status, leaving me responsible for a $14,000 colonoscopy bill! The doctor's office has not responded to literally 2 dozen of my messages, and refuse to meet with me in person. Through my own investigation, I discovered that while they were once affiliated with VillageMD, they had terminated the partnership long before my procedure and the scheduler made an error.

Having already appealed through VillageMD unsuccessfully (out of network – no preapproval), I'm preparing to appeal through BlueCross/BlueShield. What should I expect in this process? Any recommendations or insights? Anything else I should be doing? Am I likely to be held accountable for the bill?

My wife says "F-em', we're not paying anything to anybody!" Our house is paid off as are our new-ish cars, so she doesn't think a hit against our credit is anything to worry about.

submitted by /u/PaulDecember
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