First You Are In, Then You Are Out . . .

Irene Greco knew she would have to pay from her own pocket to use the surgeon she wanted, rather than one in her insurer�s network, but she thought she knew how much the additional cost would be. She was wrong � by almost $5,000.

She had her operation at a hospital that was in Oxford Health Plans� network. But Oxford, her insurer, says that because the surgeon was outside its network of doctors, the hospital bill as a whole would also be considered out of network, and therefore subject to less coverage.

I have to admit, this is a new one on me. Hidden providers are a frequent occurrence, but have not (yet) experienced a claim where a network facility was adjudicated as non-par simply because you used a non-par physician.

Ms. Greco said, �It�s an unreasonable policy that an in-network hospital suddenly becomes an out-of-network hospital just because you use a different doctor.�

Officials at the hospital and the Healthcare Association said they had never heard of such a practice until she complained to them. They say they have since learned of a few insurance policies with similar provisions, but that in those cases, the rules are more clearly stated.

This deserves more research.