In-Network? Don’t Pay Until Your Claim is Processed
Hi Friendos,
Today’s newsletter is about medical bills and financial self-defense because I had wrist surgery on Tuesday (recovery is good so far!), so that’s top of mind. My tip is a repeat of one from last year where a little repetition may be helpful: If you are seeing an in-network provider/hospital, you do not have to pay anything except your co-pay (if any) until after the claim is processed by your medical insurance company. The in-network provider/hospital might make it seem like you do have to pay everything upfront, but that is not true. If you decline upfront payment, they are not allowed to refuse service if they are in-network with your medical insurance (according to their contract with your insurer).
My surgery was on Tuesday and Monday at 6pm I got a phone call from the hospital where the surgery was taking place. The woman said I had a balance due of $2,689 and she was ready to take my credit card info for payment. I paid nothing, was 0% stressed by the call, and wrapped it in under 3 minutes because I said the “magic words.”
I have no idea if that $2,689 amount was accurate because it was based on an estimate the hospital sent earlier that day. The estimate had no line-item info and no description of my procedure at all. Even if the estimate was accurate, surgeries don’t always unfold exactly as planned, so the actual amount billed could be different.
What I did know was that this hospital was in-network for my medical insurance, though that was harder to find out than I expected. My medical insurance is through Cigna so I had gone online to my Cigna account and looked up in-network hospitals. The hospital where my surgery was taking place was not listed, so I called Cigna on the phone. I gave them the address of the hospital and asked if it was in-network. The Cigna representative said it did not appear to be, but the only way to find out for sure was to look up the hospital by its tax ID and something called an NPI number. I learned that NPI stands for national provider identifier. Once we got those ID numbers, we could see that this hospital actually was in-network for me. It was just listed in Cigna’s database under a slightly different name and totally different address because it has a complicated corporate ownership structure. The parent entity was the one listed.
Knowing that the hospital was in-network, when I got that phone call from the hospital’s billing team the night before surgery, I confidently said, “I’m going to pay my bill in full after the claim is processed by Cigna.” She said, “OK.” I said, “Is there anything else we need to discuss?” and she said nope and that was it.
I would have been so stressed out by paying an amount like that the night before surgery. It’s a lot of money and I had no way of verifying if the amount was accurate. I’m surely going to have to pay my entire $1,500 deductible for this, and perhaps all of my $3,000 annual out of pocket maximum, but at least this way I can deal with it when I can verify my actual amount owed, and not when I am feeling quite so vulnerable.
Keeping up the financial self-defense in 2026,
– Stephanie
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