The hospital provided me with a doctor not covered by my insurance plan. Am I responsible to pay the doctor?

-Last year I went to the emergency room where it was determined that I needed to be admitted. I spent 7 days in the hospital and ended up having surgery. I paid a $500 co-pay to the hospital. At some point, some doctor provided me with an inpatient consultation. I don't even know who they are nor what they did. A lot of doctors came and saw me. This person was not the doctor who did my surgery or handled my case. I don't know what they did.



Apparently this person was not covered by my insurance. My insurance company agreed to pay part of this bill. Is it usual that I would be responsible to pay the remaining balance?



I know this is probably different for every insurance company and plan, but my question is really, what is the usual way this works. I have an EPO, if that makes any difference.



I was under the impression that since I came through the emergency room and was admitted, the only things I was responsible for would be the emergency room visit co-pay and my hospital co-pay which I paid upfront.Yes you are responsible to pay the doctor. The courts have ruled many times that it is not the hospital's responsibility to check that each doctor assigned to your case is covered under your medical insurance. In my own experience, most doctor's in this situation will accept whatever your insurance pays. If you normally have a copay or deductible amount, you will need to pay that amount to the doctor in these cases.
Yes, you are responsible. However, try this: file an appeal of your insurer's claim using their established appeal procedure. In that appeal, point out that you used an "in-network" hospital but had no choice over the physician that THEY used for consultation. Request, on that basis, that the claim be reprocessed on an "in-network" basis. I successfully used this tactic for an anesthesiologist's bill. Insurers will do so but don't publicize it.
Yes, you are responsible to pay for the physician's services, even if he was not part of your insurance plan. It is not HIS fault that he's not part of the plan network. You can plead your case with the insurer, as you have here, but chances of them 'giving in' are not good.
When I go to the emergency room I write on the papers that I only will see in-network providers. That way when they pull that kinda crap I can tell them to take a hike.



It's a scam that apparently takes an additional four years of college to learn.