Out-of-Network provider wants more money

Hello, looking for advice.

I need major spine surgery (fusion). I have United Healthcare. The doctor's office says that the hospital and anesthesiologist are covered, but not the doctor.

I initially thought the doctor was in-network, but subsequently learned he is out-of-network. UHC had him at a NYC address in-network, and another NYC location OON.

So, he is OON, but the office says, "UHC only covers 'Medicare levels' for this procedure".
TOTAL SURGERY: $169.636
ESTIMATED INSURANCE REIMBURSEMENT: 0

The office said "the dr's discounted fee is $40K for your surgery."

I wrote back to say that I coudn't afford that, but I'd be happy if they could give me a recommendation for another surgeon. I then get a phone call that they don't have other recommendations (ask my insurance) and that they'd be willing to write to my insurance and see if they will 'negotiate'. She said it'd take about a month, and to let her know if I get a letter from my insurance.

All this is feeling very strange to me. Does in-network or out-of-network matter to a provider? Doesn't that just affect what I have to pay? I'd have to pay 40% and insurance 60% up to my 4k out of pocket.

What's going on here? The doctor's office has an agreement with UHC but doesn't want to honor it since they get (either medicare rate or $0)? Why have an agreement?

What is the negotiation? Isn't that what they do when the sign the contracts to work with each other?

Very confused, sad and lost.

submitted by /u/vegasidol
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