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Beware of Surprise Medical Bills

medicine and moneyYou can do everything right when it comes to health insurance: Buy adequate coverage. See in-network doctors. And go to in-network hospitals. But you can still be liable for enormous medical bills.

Insurance companies euphemistically call these surprise charges “balance billing.” The charges come about when an out-of-network medical provider does work for you — often without your knowledge. To add insult to injury, the charge you get socked with could come in at the highest possible rate, rather than the rate your insurer would ordinarily pay.

Surprise medical bills were the subject of a recent talk at the American Institute for Economic Research, during the 2015 symposium on health care economics organized by the Society of American Business Editors and Writers. The speaker was Erin Fuse Brown, a health care researcher and professor of law at Georgia State University.

(To read Fuse Brown’s August 2015 article in the American Medical Association Journal of Ethics on unfair hospital billing, click here.)

Surprise medical bills can come about in many ways. Let’s say you need to go to an emergency room. Although you go to an in-network hospital, the doc on duty just happens not to be part of your plan. Or perhaps you’re having surgery, an approved procedure performed by an in-network surgeon an in-network hospital, but the anesthesiologist on duty, like that E-R doc, also isn’t part of your plan.

Even simple lab tests can result in surprise bills, if your approved in-network physician sends the work to an out-of-network lab. In all cases, guess who gets stuck for the entire excess fee — not just the usual co-pay or deductible?

Fuse Brown’s research has turned up some harrowing examples, such as a $5,000 fee for having stitches removed. With the recent increase of narrow-network health plans, where only a small percentage of local doctors are part of a plan, she says more patients are likely to find themselves unwittingly using out-of-network services, and in receipt of wholly unforeseen out-of-pocket bills. The problem created by these bills, she adds, can be made worse by a hospital charging high interest rates for unpaid bills and engaging in harsh debt collection practices.

There is no federal protection against balance billings, and rules vary in the 25 or so states that have laws governing them. But as one of the attendees at the SABEW conference,  Richard Eisenberg of PBS Next Avenue, reported, the Consumer Financial Protection Agency gives tips to help keep medical debt in check. They are:

Review all medical bills carefully.

Keep documentation on all bills.

Check your health insurance policy and make sure your provider has your correct insurance information.

Act quickly to resolve or dispute the medical bills you receive.

Negotiate your bill.

Get financial assistance or support.

Don’t put medical bills on your credit card if you can’t pay them.

You can read the CFPA’s recommendations in detail here.

Eisenberg’s story for PBS Next Avenue can be seen here.

The report from Leia Parker of the Silicon Valley Business Journal, another of the another of  SABEW journalists who attended the health care symposium, can be viewed here.

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