“Surprise Bills”
Doctors’ Take on Breaking Healthcare News
Are you one of 30% of Americans that receive “surprise” medical bills you expected your insurer to pay?
Two major instances of a surprise bill –
- When you receive treatment from an out-of-network (OON) doctor or facility that is not contracted with your insurance company.
An example: A patient is seen in an Emergency Department (ED) by a doctor who is not contracted (in-network) with the patient’s insurer. One in five ED visits are estimated to include care from an OON doctor whose charges may be 2 ½ times that of in-network doctors. Surprise bills from OON doctors and medical facilities can run into tens of thousands of dollars.
- If you’ve met your yearly deductible, have paid your co-pay and your insurance company has paid their required amount. In other words, your bill is paid in full, yet you erroneously receive a balance due bill.
What Government is Doing About Balance Billing
Half of the states technically prohibit balance (surprise) billing and/or make patients’ insurance companies cover the charge. But many of these states limit protection to emergency care provided to patients whose doctor is OON. States lack authority over the 60% of employer-provided plans that are self-funded.
While Congress tries to grapple with the complex problem of surprise bills, in the meantime, what you can do to avoid surprise bills:
- Whenever possible, before receiving medical care from a health professional or medical facility, make certain they are in-network with your insurer.
- In Instance #2 above, give your doctor or facility the benefit of the doubt. Call the billing manager to resolve the problem.
- Scrutinize itemized bills carefully for billing errors that are very common.
- Try to negotiate a reduction in what you may legitimately owe or request a payment plan. Consider enlisting help from a non-profit professional billing company, such as Access Project.
- If the above measures are unsuccessful, you can complain to your state’s insurance department.
For additional advice about balance billing see Insider’s Guide to Quality, Affordable Healthcare, pgs. 26-31.
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The monthly healthcare forum for June will focus on what to do if your doctor(s) shows signs of burnout.