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When surgery is covered but anesthesia isn't: Coloradans caught off-guard by out-of-network bills

Major change affected one of the state’s largest insurance companies
Large out-of-network medical bills catching Coloradans off guard
Posted at 11:02 AM, May 07, 2021
and last updated 2021-05-08 00:24:50-04

LITTLETON, Colo. — Shortly before her surgery at Littleton Hospital in February, Sue Henry got a call from her anesthesiologist to tell her he was out-of-network.

“I thought it was completely outrageous. I didn’t know until a week before my surgery,” Henry said. “I have an in-network hospital and in-network surgeon, and the guy in between that’s going to make me comfortable is out-of-network.”

She tried to find a less expensive option that was in her insurance network but said she could not find another anesthesiologist within 50 miles.

“I thought about asking them if there was an in-network liquor store so I could bring in a bottle of whiskey and a bullet to bite on," Henry said.

Visiting out-of-network doctors can often lead to huge medical bills that can catch patient off guard and leave them with few options.

At the center of the issue are contract disputes between insurance companies and anesthesiologists.

Denver7 Investigates went searching for answers and discovered that Henry wasn’t the only one having this problem.

“It’s just desperately unfair to have networks that are so small that you can’t find an anesthesiologist in 50 miles,” said Dr. Anna Weyand, president of the Colorado Society of Anesthesiologists. “It’s really tough on our patients.”

Weyand accuses insurance companies of canceling contracts early and offering anesthesiologists unreasonable rates.

“The insurance companies are cutting contracts, limiting who can be in their network,” she said. “It is not a case of the anesthesiologists going back and saying ‘hey, we want to make more money.’”

MORE | Why Colorado still might not help you avoid surprise medical bills

Weyand points to a February 2020 survey by the American Society of Anesthesiologists. It found that insurance companies terminated contracts with more than 40% of the anesthesiologists who responded to the survey, essentially forcing them out-of-network.

Following Henry’s surgery, she said she received what looked like a bill from her insurance company, UMR – which is administered by United Healthcare. Her explanation of benefits said she could be responsible for up to $1,200 in out-of-network costs to pay her anesthesiologist.

“I mean that’s a lot of money. I’m retired,” Henry said.

The disputes between insurance companies and doctors are also now at the center of a legal battle.

“Particularly, United, in my experience, has been sort of the most aggressive of the insurance companies,” Weyand said.

U.S. Anesthesia Partners of Colorado (USAP-CO) filed a lawsuit in March in Denver District Court. It accuses United Healthcare of offering “surgeons in Colorado … approximately 50% more compensation” in exchange for not using their anesthesiologists.

The lawsuit also states that, “United is like a boa constrictor squeezing USAP-CO from all angles.”

In response to the accusations and the lawsuit, United Healthcare said the claims in the suit are “completely meritless” and accuses USAP of a money grab.

“U.S. Anesthesia Partners was demanding to be paid rates that are more than 70% higher than the median rate we pay other anesthesiology groups that participate in our network in Colorado, which helps meet the profit expectations of its private equity partners but also drives up the cost of care,” United Healthcare said in an emailed statement from a spokesperson.

United Healthcare blamed the anesthesiologists for surprise billing its members.

“We hope USAP will rethink its decision to take advantage of its patients to maximize profits,” the statement said.

Both sides are arguing about bottom lines, but patients are the ones who are caught in the middle between doctors and the insurance companies.

“And that is not right,” Henry said. “I just don’t understand why they have left me with no option.”

After Denver7 Investigates started asking questions, the anesthesiologist group took a closer look and was able to take care of Henry’s bill.

United Healthcare said it has more than 420 anesthesiologists and nurse anesthetists who provide in-network care, but it encouraged patients to call the number on the back of their insurance card prior to having surgery.

The Colorado Division of Insurance (DOI), which regulates most insurance plans in the state, recommends patients work with their insurance company to find a solution. If not, patients could be stuck with out-of-network bills. The organization added that companies should work with consumers to find an in-network provider and if one is not available, then the company should work with the consumer to go out-of-network.

Additionally, patients should not go with an out-of-network provider and assume their bill will be paid.

Colorado recently passed legislation to prevent consumers from being surprised bill, but we found it doesn’t apply to all insurance plans, including those that are self-funded and therefore regulated by the federal government.