I’m being charged $10k from a facility from my insurance, despite the facility saying I owe them nothing

Heres the rub: I have UHC PPO through my wife's employer. I had an endoscopy performed in February and prior to that, I confirmed with UHC that my doctor would be in network. I'm pretty young, and this is the first time I've had a procedure like this that my parents didn't deal with for me, so I neglected to check if the Anesthesiologist and facility were in network. I didn't even know I needed to ask that. Days prior to the procedure, I get a call from the facility informing me that the facility is out-of-network but that they honor the insured rates for those whose doctors are in their network and that the charge would be $300 up front. Not wanting to delay this procedure any further, I approve.

I get the procedure done, and a few weeks later I received bills from the doctor who performed the procedure and the lab that tested the result, which was mostly covered by insurance. 3 months after that, I receive bills from both the facility and the anesthesiologist for $10,000 and $1750, respectively. Insurance is covering $0 for these claims. I appeal the claims, both of which are denied. I speak to a supervisor at UHC about what my options are here and she finds it strange that I was not balance-billed for these (she explains what that is to me but I still struggle to really understand it, but she says I should not be paying the "market rate" for these). She tells me shes going to obtain all the documents from the facility and Anatheseoligist and file a claim for balance billing.

In the meantime, I call the billing department for the facility to obtain the docs myself for my own knowledge, and they told me I owed them nothing, and that the $300 I paid upfront was the facility fee. I'm looking at a document of transaction history from the facility right now that shows this payment less the $10,000 facility fee, and then a "Commerical Adjustment" of -$9700, making my balance due $0.00.

If the facility says I owe nothing, why does my insurance say I owe them $10,000? I have the option for a 2nd appeal, but I'm hoping to go in there with a little more ammunition than my first appeal. And I don't even know where to start with the anesthesiologist bill…

submitted by /u/TonyFunkenstein
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