Surprise bill reprocessed with our-of-network deductible applied

I had a minor procedure done last December at an in network facility by an in network physician which provided me with a written estimate of $0 patient financial responsibility estimate due to having met my in network annual out of pocket maximum. It processed with a separate $10,000 claim for the anesthesiologist, who I was not told was out of network, and insurance denied coverage. I submitted a request it be reprocessed under the surprise bill law and submitted all my documentation showing the $0 patient financial responsibility estimate. This was pending for many months and now completed reprocessing with the result that I owe $1,500 in coinsurance towards my out of network limit and insurance is paying the remaining $8,500.

I thought this was supposed to process at in network rates – shouldn’t my in network maximum apply too? It seems they did apply my in network coinsurance percentage but there’s no way $10,000 is the in network insurance agreed upon amount. Should I appeal? Or wait and see if I get a $1,500 bill? For what it’s worth, the $10,000 bill only came after my initial 180 day appeal period was up so I don’t want to risk that happening here. I was proactive last time and took action based on the EOB, which I believe I could attempt here too. Anyone have advice? This is in New York State if that makes a difference, and I have Independence Blue Cross PPO.

submitted by /u/mindysmind
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