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Ask Dave

Insurance Won't Pay

Jared and his wife recently had a baby. They received a bill for $2,300 from the anesthesiologist. The insurance claims the doctor wasn't in-network. What should he do with this bill?

QUESTION: Jared in Houston and his wife recently had a baby. The insurance company was supposed to cover all in-network expenses minus a flat $250 fee. They received a bill for $2,300 from the anesthesiologist though. The insurance claims the doctor wasn’t in-network. What should he do with this bill?

ANSWER: BlueCross BlueShield will vary dramatically in their level of service and how much of this kind of crap you have from state to state. They’re independently operated in each state. Some states, they’re barely open. In other states, they do a great job. Obviously, you’ve had trouble in your state that is a dramatic problem.

I guess you’ve got two choices. I would call the anesthesiologist and explain what has happened in detail. Explain the extent to which you’ve gone to try to get them to pay, and say, “Obviously, I owe you this difference. I had no idea. I was expecting $250. What will you take?” Just try to negotiate with them—not on the basis of you can’t pay it but on the basis of you need a discount because you’re not insured for the anesthesiologist.

You’ve probably made the determination that it’s probably not worth suing BlueCross for $2,000. No, I probably won’t do that, but I will probably give them more than $2,000 worth of bad PR on The Dave Ramsey Show with 6 million listeners. Oh darn! I hate it when that happens.

They just play games with this stuff—some of these companies do. I’ve got BlueCross, and in Tennessee, BlueCross does a pretty good job. But it is independent from state to state. You’ve got to judge them a little differently than, say, if it was a company—the typical company that is the same from state to state.

In your case, what would I do if I were in your shoes? You’ve exhausted all reasonable possibilities. I don’t think suing them in this case is probably worth the trouble. I would call the anesthesiologist. Have a conversation with the guy personally. It’ll probably take several phone calls to get that done, but it’s worth it for $2,000. Say, “This is what I’ve got—$2,800. I’ve already paid $500. I went through this, this, this and this. I filed, I re-filed, I appealed, and I filed with the state. I’ve done everything I can do. They’re simply not going to pay it, so I owe it. Help me out here, my brother.” See if you can get a guy to just be reasonable and give you some mercy. He may say, “All right, I’ll split it with you. I’ll take $1,000.” That’s probably what’ll happen. Get that in writing from them and send them a check immediately—as soon as you have that conversation. That’s what I would do were I in your shoes. I wouldn’t fool with suing an insurance company over $2,000.