My wife made an appointment for cat scan on physician assistant's recommedation for a Tuesday. She gave them our insurance (stellar Blue Cross Blue Shield of Massachusetts PPO, not Obamacare) info and was informed it was accepted.
Perhaps because I am the primary, it was me that received a Monday voicemail after 5:30pm confirming and to bring a $350 co-payment. My wife was quite surprised as they did not tell her of the high co-pay at the time of scheduling, and also surprised as I had an MRI and a cat scan at Desert Radiology a few months ago where I only paid $20 per procedure. Thinking they did not process our insurance info, I called the Steinberg insurance dept. lady, and was told that I had to meet said deductible and then it would be smaller co-pays after that. Upon further questioning, her voice started to sound a bit shrill and nervous; not quite clearly explaining to my satisfaction. I politely thanked her for her time, and she sounded relieved, thinking I had understood. I decided to call my insurance company who informed me that Steinberg is not in our approved service provider network and promptly e-mailed a list of approved providers.
Upon my wife calling to cancel the appointment, explaining that our insurance did not approve of Steinberg as a provider, the scheduler asked if my wife would hold as she was going to check with the in-house insurance lady. She came back and nervously said "Yes, you ARE accepted. You have to meet a thousand(?!) dollar deductible....." and then went into nonsensical sentences basically trying to explain how OUR insurance works in conjunction with their shop. It seemed as if she were trying to memorize whatever she had just been told, whereupon my wife gently interrupted her to confirm the cancellation and wished her a good holiday. The scheduler sounded dejected as the call ended.
I surely understand Steinberg's policy of not informing us that we were out of network and that they were certainly aware that using any out-of-network provider would entail a $1,000 deductible. After all, they are a business shilling for more money and they might say that it is not their responsibility to inform patients that 'hey, we are not in your plan, this will cost you X amount of dollars' at the time of scheduling. We all know that insurance companies never pay the full amount submitted by providers. After all, Desert Radiology received $600 from my insurance company for my cat scan. Perhaps Steinberg's gain in this process is that they would have collected payment in full from us versus the insurance company sending a smaller percentage of money for that service 90 days later.
But at what point does reasonable humanity come into play in our healthcare? Patients, do your homework.