Even after ensuring their doctor and their facility are in their insurer’s network, patients can still get hit with surprise out of network medical bills.
Out of network health care can come at a significantly higher cost for insured patients. Many health insurance policies are structures to steer patients towards care providers within the insurer’s network. These policies may provide little or no coverage for out of network providers.
Facilities may be in or out of network as well. Physicians aren’t necessarily within the same networks as the clinics or hospitals where they practice. It can take a little research for an insured patient to be sure both their provider and facility of choice are within their plan’s network.
But as a patient’s care needs get more complex, the likelihood increases that it will involve out of network care providers. Lab work for an in network provider may be outsourced to an out of network lab, for example. Or surgery with an in network surgeon may involve an out of network anesthesiologist.
Even a patient who diligently chooses an in-network provider and facility may not be able to ensure all other providers are in-network. Patients in these circumstances may then find themselves receiving surprise out of network medical bills. And because these services tend to qualify for less, if any insurance coverage, the bills they can generate can be considerably pricey.
States Respond to Surprise Out of Network Medical Bills
A bill proposed in the Arizona state legislature would set up an arbitration system for patients who want to dispute their out of network bills.
According to an article on azcentral.com, patients who get care at an in network facility could seek arbitration of surprise out of network medical bills of $1,000 or more.
The patient would initiate the process by contacting the state Department of Insurance. The insurer and the care provider would be expected to try to resolve the dispute themselves through one informal conference.
If that conference doesn’t yield a resolution, the dispute could then proceed to arbitration. The arbitrator would be appointed by the Department of Insurance, and the cost of arbitration would be split between the insurer and the care provider. The arbitrator’s decision would be appealable to state court.
Other states’ legislatures have enacted similar laws in an attempt to take the sting out of surprise out of network medical bills. Under similar legislation in Texas, 94 percent of such disputes are resolved through negotiations between the insurer and the provider, without having to proceed to arbitration.
The Arizona bill would also restrict what’s known as “balance billing” – billing the patient at a higher rate the provider would bill an insurance company. Balance billing results from the leverage insurance companies have to negotiate lower rates from providers.
Even under existing law, patients hit with out of network medical bills they weren’t expecting may be entitled to compensation. Checking with a knowledgeable insurance attorney is the best way for such patients to understand all their legal rights and options.
Join a Free Surprise Medical Bills Class Action Lawsuit Investigation
If you received a bill from an out-of-network doctor after being treated at an in-network hospital, you may qualify to file a surprise medical bill lawsuit or class action lawsuit. It’s absolutely free to take part in an initial consultation, so act now!
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