In Mar 00 my 11 month old daughter was diagnosed with chronic ear infections and referred to the above facility for evaluation and tubes in the ears for drainage. Upon the evaluation we were referred then to Springfield Surgical Center for the surgery.
I also had the option of Children's Medical Center. Being that the doctor was in Springfield, we live in Springfield, it made more sense to do this at the Surgical Center. Keep in mind to do this with an HMO Insurance (Cigna Healthcare of Columbus) it must be pre-approved. We received a letter from Cigna stating this would be an out of network surgery and a 500.00 deductible would apply.
I immediately called the doctors office and the surgical center in question. The surgical center assured me that they accept whatever the insurance pays (and the Surgical Center did) and we would be out of pocket no money. We made the assumption that this included the entire procedure (doctors and all). We were wrong. Wrong doctor too! We made her follow up appointment and waited over 1 hour for the doctor to even show up. Then, his fill-in treated her like a puppy and looked in the wrong ear and I had to pay a co-pay for that?!
Finally, we received bills that I questioned via Cigna. They informed me through the ENT office that the doctor also is considered out of network even if he is an in network provider, then said my original physician filled out the paperwork wrong. This was not the case. It was just unclear that the doctors were separate billing and that they were considered out of network for the procedure as well.
Meanwhile, we provided a letter to ENT Associates contesting the bill and why asking for a response in writing, no response was ever received. However, attempts were made to call my wife at her place of employment. We then appealed to the insurance company again sending a copy of this letter to ENT Associates. Cigna denied the appeal.
Today, we received a "nasty" delinquency notice in the mail. Subsequently I called the ENT office to clarify the matter and was not as congenial as my wife tried to be. I met with "nasty" responses over the matter -- Lisa of ENT Assoc said that computer read that Cigna told my wife this "several" times (insuating she was being diffult). Which is entirely not the case. The conversation was on my dime, therefore, I spoke my piece and I was not very friendly. We ultimately told them to send the matter to collection and pay for that so at least they are out some of the money we apparently owe. We will pay the bill once they've taken the time and money spent to collect a whopping $157.00....
It's not the money it's the deceptive practices and assumptions you are given from this office -- BEWARE of "we'll absorb all the insurance does not pay" from any procedure your doctors order.