<prompt> Human: I had a surgery in September 2017 and apparently a nurse in the operating room was out of network and my insurance paid only 168 of the 4,000 bill. Im pretty angry that this is even possible, as I wasnt notified beforehand that I would end up with this bill and dont want to use my emergency fund for something like this. I dont understand why they used a facility and surgeon and anesthesiologist etc in network but not the nurse. To make matters worse, I wasnt even aware there was an outstanding balance until a collections company sent me a notice. They said they have already sent three notices and that the nurses office sent several notices to an old address but I did not receive them. I have until August 5 to pay before it is reported to the credit bureaus. What are my options? Edit: I cant believe the amount of replies here! Ive read every comment and appreciate the input and peoples general sympathy about how stupid and absurd this situation is. Ive requested the bill and will make sure its itemized. I will call the hospital, insurance company, and surgeon in the morning and hopefully I can get something resolved ASAP. I will update again tomorrow if Ive gotten anywhere.If anyone has advice on what to do about the collections, this is my main concern. I only have until August 5th and I will be trying to deal with this while I am out of the country for the rest of the month. I invest in real estate and am in a perpetual state of trying to buy property, so my credit score is incredibly important and Ive taken very good care of it. Edit 2: Ive called the hospital and they were not helpful. They told me they would send an out of network letter and had nothing else for me.I called my insurance and they are resubmitting the claim to the claims department again to see if they will pay it, and said they would mail me an explanation of benefits. I will call the collections company and tell them I am disputing the claim. I am going to call the nurses office now and ask them to withdraw the collections thing and give them the reference number I received from UHC showing that the claim has been resubmitted and that I am working on taking care of the bill. Edit 3: I have called the collections company and the person there was really hostile. The hospital did not have contact information for the nurses office and the collections company would not give it to me. Assistant: Unfortunately this is not uncommon in the American medical system. A lot of hospitals have people working at their facility who are not technically employed by that hospital. So you can get surgery preauthorized and covered by your insurance, go to a hospital thats in-network, be treated by an in-network doctor, but have an anesthesiologist, nurse, lab test, or other service from a third-party that isnt actually covered by your insurance. It sucks, but its legal in most states. And no, you usually wont be informed of this possibility until after the bill has been incurred.You need to talk to your insurance and the third-party provider right away. Dont delay. When you contact the third-party provider, tell them youre negotiating this with your insurance and ask for a discount and payment plan. You might end up having to pay the bill, and then fight your insurance company to reimburse you. Dont let the bill pile up. Pay it in installments if you have to, because legally you do owe it, unless youre in one of those rare states that makes this practice illegal. Also, cross-post this to rhealthinsurance for more advice. Edit: heres a New York Times article with more info and some suggestions on how to deal with these shitty situations. Human: I cant believe this is even a thing. Ive requested a copy of the bill and will try all of the things you and someone else mentioned. Thank you! Ill update when Ive got something worked out in case this happens to anyone else.  <response>: Best of luck. Fight the good fight! 