I assume that your daughter's hospital visit was covered by in-network insurance, but the in-network hospital employs an out-of-network physician. The facility fees etc. totaled about $2,300, which the insurance company covered less the normal ER deductible, and the separate bill of $1,180 was NOT covered in full because the resident's services were out of network. Am I correct? I'm not clear on whether your insurance believes the total you should owe, including all deductibles, is $650 or that's just what they think you should pay for the doctor's services.
Regardless, there are several relevant issues. Please note this is NOT my area of expertise, but I do have some familiarity with healthcare cost issues and this should give you some avenues to explore.
1) You are entitled to a fully itemized bill from both the hospital and the physician. Up to 80% of medical bills contain errors. Once you get the itemized bills, including codes, you can look up the codes on the American Medical Association’s website.
2) Care levels are standardized and physicians normally have to meet three criteria to justify billing at a certain level. You are entitled to written explanation of the level billed. It is a red flag if the hospital and the doctor billed at different levels.
3) How is a resident out of network? The federal government pays a lump sum to hospitals for each resident, and the hospital also makes money off the poor kids for the billing they generate. I do not understand why you should be getting bills from a physician service if your daughter saw a resident. The hospital needs to explain this.
4) It's unacceptable for any medical service not to respond to your requests for documentation.
5) This is called balance billing, or surprise billing. Virginia HB 1584 will address this, but it will not go into effect until next year.
6) You should contact the hospital's Risk Management department. They use the physicians' service; they are ultimately responsible for the care given and the billing created under their auspices.
7) Your insurance company may have an advocacy department that can help.
Just as general advice: train your family to write on every form; "I will not be responsible for out-of-network charges unless these are cleared with me first." Patients get surprise bills for out of network lab bills, therapy, all kinds of things. Healthcare costs are a major headache and unfortunately we have to teach our children (and ourselves) how to minimize the craziness.