You think you’re doing the right thing. You head for the emergency room after your son twists his leg badly while playing football. You want to find out the extent of the damage. You checked and found out that this hospital facility is within your health insurance network and are convinced you will have coverage.
Later you are surprised when you get a bill for close to $1,000 and you find out that the doctor who treated your son wasn’t in the network.
A new study published in the New England Journal of Medicine finds that, across the country, 22 percent of people visiting in-network emergency rooms have to deal with bills from out-of-network doctors.
“It’s crazy,” Zach Cooper, assistant professor of public health and of economics at Yale University, who led the study, told NBC News.
“You, as the patient, have absolutely done the right thing. You’ve gone to an in-network hospital, and a doctor who you didn’t choose, who you couldn’t avoid, ends up not being a member of your network and weeks later sends you a bill for tens of thousands of dollars that you’re on the hook to pay.”
“We believe the best solution would be for states to require hospitals to sell a bundled [ER] care package that includes both facility and professional fees,” Cooper writes in his report, published in the New England Journal of Medicine.
Cooper and his colleague Fiona Scott Morton analyzed claims from a large insurance company covering tens of millions of people.
“Our results are deeply troubling: of the 99.35 percent of [ER] visits that occurred at in-network facilities, 22 percent involved out-of-network physicians,” they wrote.
“In McAllen, Texas, and St. Petersburg, Florida, surprise-billing rates were 89 percent and 62 percent respectively,” they added. “In contrast, in Boulder, Colorado, and South Bend, Indiana, the surprise-billing rate was near zero, suggesting that surprise billing is a solvable problem.”
Cooper’s solution: legislation. The incoming administration of President-elect Donald Trump has promised to overhaul health care reform but hasn’t addressed the issue of surprise medical bills.
Kristine Grow, a spokeswoman for America’s Health Insurance Plans, agrees it’s a problem and says the entire industry needs to help.
“Health plans negotiate lower prices with in-network hospitals and doctors — and depending on the specific insurance, plans cover a significant portion of these costs,” she said in a statement.
“But when a doctor is not part of a plan network — even if they separately contract with a hospital to treat patients there — they can charge much higher rates. That’s when patients receive a surprise bill. It’s a growing problem that puts patients in a frustrating and costly position.”
While we are not in the insurance business, at Theodoros & Rooth, we represent patients who have been seriously injured due to a doctor’s, hospital’s, or other medical provider’s negligence. If you think that you have been a victim of a medical provider who has treated you irresponsibly, and it has resulted in a serious injury, let us know about it. If we believe you have a case, you can be assured that we will represent you and stand up for every right you have. There is never a charge for a consultation and we only get paid as part of a case that we win on your behalf.
NOTE: Much of this information was taken from a recent report by NBC News.