Dd was born over a year ago and ever since then we've been trying to fight our insurance. We are getting billed for the hospitals pediatrician bc he's not in network. We didn't even have a choice! She was whisked away and examined by him bc there was meconium in my water. Anyone have any advice or concrete citations that I could use? We already wrote a long letter and they wrote back denying it :( help!

So sorry to hear that WM.....  Did you lodge an official appeal through your insurance company?

Yes. I can't believe they declined it. :(

I'm not sure what else you can do on the insurance company's end, but maybe contact the hospital and ask to speak to a patien liasion?  That is what I was told to do. (I still have to make the call) 

DS was placed in the NICU 24 hours after being born because he was spitting up old blood (it was mine, not his) and they almost sent him to the children's hospital.  Once they figured out what was wrong the doctor said he could come back to my room as soon as he was done with his IV.  Well, they charged us for the NICU from the time he went over there until we went home.  So I'm fighting it.  The NICU was 4200/day and the regular nursery was 820/day.  I have to pay 10%, and even then that's a significant difference! 

I have no advice but I hate insurance!

What a nightmare! I am super-limited in my knowledge here, but isn't there some sort of liasion at the hospital that could write a letter on your behalf? Would the hospital accept an offer of compromise? It is soooo crazy when the baby goes to the NICU. Everything happens so quickly, there is absolutely NO time to weigh decisions. It sounds like the insurance company is trying to take advatage of your situation.

So the hospital you were at was in-network but the pediatrician they had on staff was not?? Do they have any pediatricians on staff that are within network? If not that might be a point that you could legally play to your advantage. If they did have an in-network pediatrician on staff AND available it seems like (and we know corporations, which hospitals ultimately are, do not always work logically) the responsibility would be on them to "assign" this person to you. They collect insurance when you are admitted so they should have known this. Crazy to expect you to stop and ask if the pediatrician is in-network...who does that??