Tamara Burns  |  September 22, 2017

Category: Consumer News

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surprise out of network medical bills hospital doctorFor many, surgery is a necessary evil that is undertaken to improve one’s quality of life. After finding out surgery is needed, most individuals call their health insurance company to make sure the surgeon and hospital are both in-network to avoid any unnecessary costs.

After getting confirmation of in-network status, patients tend to let their guard down some. They know that they may still be responsible for hundreds or even thousands of dollars to pay their portion of the insurance for deductibles and coinsurance. But typically, these costs are manageable, even if they were unplanned.

However, what some patients don’t know is that surprise out-of-network bills may be headed their way after their procedure. These bills can be for an exorbitant amount, leaving patients frustrated, angry and worried that they will not be able to pay the bills they owe.

What are Surprise Out-of-Network Bills?

Surprise out-of-network bills are bills that come from providers who the patient reasonably assumed would be in-network. A doctor may have referred to a surgeon who worked in a hospital, and a patient may have assumed that since their doctor was in network, so was the surgeon and hospital.

Other times, surprise out-of-network bills come from other expenses that the patient didn’t actively consider. These may include imaging studies in radiologists, laboratories, outpatient facilities, anesthesiologists, consulting surgeons, doctors or other personnel and more.

Additionally, ambulance services may be out-of-network. If 911 is called for an emergency situation, the last thing the patient will be thinking about is if the ambulance is an in-network provider. Unfortunately, emergency transportation bills can add incredible expenses.

When a patient sees an in-network provider, typically, more costs are covered under the patient’s health insurance plan. The providers have agreements with the health insurance company in terms of how much they will be reimbursed for their services.

Out-of-network providers, on the other hand, do not have agreements with insurance companies. So their billings tend to be much higher, and the amount of costs that are covered for an out-of-network provider by insurance companies is typically much less as compared to those in-network.

Surprise out-of-network bills can have devastating financial consequences, and many are questioning the practice. In fact, more than a dozen states have passed legislation surrounding practices of surprise out-of-network bills, and there is some work being done at the federal level. But largely, there are big gaps in terms of what patients are experiencing and the legislation to protect them from these potentially financially damaging bills.

A study of surprise out-of-network bills filed under New York health insurance plans found that the average was $3778 per case for emergency care. If assistant surgeons were out of network, the bills averaged $12,210.

Who is Most Likely to Receive Surprise Out-of-Network Bills?

If you have a self-funded employer plan, you are at the most risk of receiving surprise out-of-network bills, as only the federal government can regulate such plans. Those who have a fully insured plan offered by the employer and those covered by ACA and other individual market plans have a lesser risk, but still may deal with surprise out-of-network bills. About ¼ of states have attempted to curtail the practice.

If you are covered under Medicare, Medicaid, Tricare or VA healthcare, you can rest easy, as you likely have full protection from surprise out-of-network bills as a member of these healthcare programs.

Taking Action over Surprise Out-of-Network Bills

If you received surprise out-of-network bills despite being treated at an in-network hospital, you may be eligible to seek legal compensation. An attorney can provide you with a free consultation to go over your potential case to see if you qualify.

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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