What should I expect?

Hi! I am not very knowledgeable with insurance and am looking for any helpful advice.

I have to have an outpatient procedure every few years. I normally have it at a specific surgical center except my doctor’s office called me and said they do not take my insurance, so I would have to have it at the hospital, which is where her office works out of. So I scheduled it. I talked to the hospital a few different times and they told me I’d only owe $400, letting me know that the morning of as well.

Fast forward to now, I received a bill in the mail from the hospital for $11,621.50. The total surgery cost $23,954.00. I called my insurance company immediately. They did not receive anything on their end except that I might owe $800. So the agent calls me back after talking to the hospital and says the number is accurate and that they will refill it, to give it 30 days until I call the insurance company back. They then told me the hospital is out of network. I had no clue, I see her at the office attached to the hospital and I’ve had blood work done at their other locations. I called my doctor’s office to speak with the woman who originally scheduled me and she said the hospital is open network and that the surgery was medically necessary, not elective. I called back the insurance company and they said that just because it’s open network doesn’t mean they are affiliated with them.

I am expecting the worst. I realize I went wrong letting my doctor’s office handle all of it without double checking myself. Am I screwed? I also don’t understand how I don’t owe more than the 11k if it’s out of network, as the operating room itself cost $12k and the recovery room was 7k. My doctor’s office says it was a medically necessary procedure, not elective.

submitted by /u/theorigamicrane
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