Couple receives surprise bill after doctor at in-network facility turns out to be out-of-network
Apr 11, 2022, 6:20 PM | Updated: Jun 19, 2022, 10:01 pm
MURRAY, Utah — Imagine going to an in-network medical facility but then getting a surprise bill because the facility’s doctor turned out to be out-of-network. It happened to an Elko couple.
All the Is were dotted and Ts crossed — the procedure was approved and everything was in-network, or so they thought until the bill arrived.
Theresa Mancuso used to work in medical billing. So, when her husband, Mike, needed an MRI, they got everything pre-approved and confirmed the imaging center is in their insurance provider’s network.
“We did our homework,” she said. “We did everything we should have.”
But the bill came in at close to $4,000 — double what they were expecting. The Mancusos combed through the paperwork.
His brain scan was preapproved and at an imaging center in-network with a Nevada men’s insurance provider. So how did he end up with a nearly $4000 out of network bill? You ask, @KSLInvestigates tonight on @KSL5TV News at 6PM. pic.twitter.com/lqYubK9O2u
— Matt Gephardt KSL-TV (@KSLGephardt) April 11, 2022
“The doctor – not the facility – the doctor was not in-network,” Theresa said.
A radiologist the couple said they never met was apparently not in-network at the in-network facility. They said their appeals went nowhere. Not wanting to pay a surprise bill they worked to avoid, the couple decided it was time to call the KSL Investigators.
So, this time, we reached out to Mountain Medical Imaging Center on the Mancusos’ behalf. A company spokesperson declined an on-camera interview, but by phone told us this all should have been handled differently.
Mountain Medical said the reason the radiologist was out-of-network is because the doctor was new to the practice and the insurance company had not quite added them to the network yet.
When the out-of-network bill came, Mountain Medical said its billing company should have taken what the insurance company was willing to pay. Mountain Medical told us it is their policy to never pass these types of bills on to patients and are now working with their billing company in hopes it does not happen again.
“I didn’t want to pay $4,000 for something I didn’t do,” Theresa said.
And just like that, some good news for the couple — just minutes after I spoke to Mountain Medical, they got a call that their bill was being waived.
Alas, this is not a unique story. In the U.S., we have so many different insurance companies and medical groups that it can be a gauntlet trying to figure out if everyone who may see you during a medical visit is in-network. Unless it is an emergency, the responsibility of sorting it out usually falls on the patient.