Does a doctor and the hospital she is affiliated with have to take the same insurance?

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Does a doctor and the hospital she is affiliated with have to take the same insurance?

When I gave birth to my second child I went to an OB that was a participating provider with my insurance company. She delivered my child at the only hospital that she is affiliated with. I recieved a bill in the mail from the hospital stating that they are "out of network". How can a doctor take an insurance that the hospital she is affiliated with does not?

sarah314

Doctors and hospitals are separate entities. They negotiate their own contracts with insurance companies, and are under no obligation to contract with the same groups.

A doctor may have admitting privileges at several hospitals - ultimately it is the patient's responsibility to confirm that they are going to both a network doctor *and* a network hospital.

A person should *always* be aware of what hospitals in their city are part of their insurer's network. Even if they aren't having a planned service.

Unfortunately, there's nothing you can do in this case except pay the bill. If you are low income, you could try to see whether the hospital will give you a charity discount on the bill. (They aren't obligated to do so, however.)

mbrcatz

Well, it happens, but you really need to appeal this with your insurance company.

acermill

You can appeal, but it's your responsibility to insure that all facilities you intend to use are within the network. Why didn't you ask ?

Spring

First, call your doctor and let her know that. Second, make sure you have all the right documentation - including copies of what you have stating that she was a participating provider.

But, make sure you call your doctor, she might be able to offer some kind of help.

Custo

Its ridiculous, I know... They SHOULD all take the same insurance plans, but sadly, they don't. Maybe one day... Typically, in order to participate with an insurance company, a doctor must have privileges at, at least one, in-network hospital. Seems kinda fishy... Call the doctor first. Ask. Then call the insurance company. Maybe the made a mistake. Good luck

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