Options for getting insurance to cover out-of-network emergency services?
We live in the US, in a state that prohibits balance billing unless you give written consent and give up your protections. NJ.
My son tore his lip open last summer and received emergency plastic surgery to stitch the lip back up. We used an out of network plastic surgeon in the hospital because he is highly recommended among our community. At the time, they provided me with a form to sign that I guess waived my rights and satisfied the Surprise Billing law. I signed it because my son was screaming in pain with his lip half open and they couldn’t start the surgery until I signed. I skimmed it and it said the most they can charge is 18k but the Dr explained after insurance it’ll probably be lower.
My insurance only covered 1,500 and now I’m on the hook for 16,500. My question is: what are my options for getting insurance to cover more? The Dr entered an out of network open negotiation with the insurance but they haven’t responded. How do I get my insurance to enter the negotiation with the Dr? I called the insurance and it didn’t lead anywhere. Are there any special phrases or terms I need to use to get the insurance to enter negotiation?
Side point: I get that the surprise bill law was meant to protect patients but how does it make sense that all rights are waived with a signed form when that signing is done at an extremely tense and stressful moment? Who in their right mind would refuse the emergency care when their child’s lip is dangling from their face?
submitted by /u/ahumanguy9
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