Couple receives surprise bill after doctor at in-network facility is out-of-network

MURRAY — Imagine going to an in-network medical facility but then getting a surprise bill because the facility's doctor turned out to be out-of-network. It happened to an Elko, Nevada, couple.

All the i's were dotted and t's crossed — the procedure was approved and everything was in-network, or so they thought until the bill arrived.

Theresa Mancuso used to work in medical billing. So, when her husband, Mike, needed an MRI, they got everything preapproved and confirmed the imaging center is in their insurance provider's network.

"We did our homework," she said. "We did everything we should have."

But the bill came in at close to $4,000 — double what they were expecting. The Mancusos combed through the paperwork.

"The doctor – not the facility which it was (authorized) for – the doctor was not in-network," she said.

A radiologist the couple said they never met was apparently not in-network at the in-network facility. They said their appeals went nowhere. Not wanting to pay a surprise bill they worked to avoid, the couple decided it was time to call the KSL Investigators.

So, this time, KSL reached out to Mountain Medical Imaging Center on the Mancusos' behalf. A company spokesperson declined an on-camera interview, but by phone told KSL this all should have been handled differently.

Mountain Medical said the reason the radiologist was out-of-network is because the doctor was new to the practice and the insurance company had not quite added them to the network yet.

When the out-of-network bill came, Mountain Medical said its billing company should have taken what the insurance company was willing to pay. Mountain Medical told KSL it is the center's policy to never pass these types of bills on to patients and is now working with its billing company in hopes it does not happen again.

"I didn't want to pay $4,000 for something I didn't do," Theresa Mancuso said.

And just like that, some good news for the couple — just minutes after I spoke to Mountain Medical, the Mancusos got a call that their bill was being waived.

Alas, this is not a unique story. In the U.S., there are so many different insurance companies and medical groups that it can be a gauntlet trying to figure out if everyone who may see you during a medical visit is in-network. Unless it is an emergency, the responsibility of sorting it out usually falls on the patient.

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