Can your health insurance cover a hospital without covering the attending physician the hospital assigned?

I n April I was taken to the hospital via ambulance having multiple seizures. I went to a hospital that my insurance considers in-network, but then they said that my attending physician (whom I was assigned not that I chose) was not considered in-network and was only partially covered . I spent about 5 days in the hospital. We are being charged nearly $1200 just for the physician that we did not know was out-of network. Can the insurance company do this? Is it standard policy with all health insurance?
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The short answer is: yes, they can, and they do. Hospitals, doctors that have hospital privileges, and the labs in the hospital are all considered separate entities and bill separately. Not all of them participate in every health insurance plan. Now, in your case, you have grounds to appeal. Since you were admitted to the hospital on an emergent basis and not via your own personal physician, therefore having no say in which doctors treated you, I suggest you first call the the provider that is billing you and let them know you're going to appeal it with your insurance company and that you will keep them informed, and ask if you can count on them to help if you need it. (They will probably agree - they want to get paid, and they generally don't care by whom.) Then call member services at your health insurance company and explain the circumstances of your hospitalization and ask them to reconsider the claim, if they can not, ask them how you can appeal it - including the contact name and address and a phone number if it can not be accessed by member services. You might have to jump thru some hoops for this - insurance companies count on that - but if you're persistant, you should win. (Enlist the help of your regular physician too! They can often provide documentation of medical necessity.) Good luck!
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