Balance Billing Out of Network Leaves Patients with Massive, Surprising Medical Bills

New consumer feedback suggests that balance billing out of network may be a widespread problem for Americans, resulting in unexpected medical bills and large invoices.

A Kaiser Family Foundation poll recently found that 67 percent of individuals stress about unexpected medical bills.

This percentage is larger than the percentage of people who worry about insurance deductibles, prescription drug costs, or the costs of rent, food, and gas.

This fear is not unfounded, with four out of 10 individuals having received a surprisingly large medical bill within the past year.

Of those who said they received a surprisingly large medical bill, a quarter attributed it to a balance billing out of network.

Out of network providers may not accept the amount that an insurance company offers to cover for a service or test and will bill the remaining balance to the patient in a practice known as balance billing out of network.

Balance billing out of network often occurs with laboratory testing or for physician services. However, it can occur for emergency medical care.

Balance Billing Out of Network and ER Visits

Balance billing out of network is shockingly common. It can happen when hospitals hire doctors through physician contractor groups such as the popular company EmCare. EmCare is a division of Envision Healthcare and offers staffing for emergency rooms around the country.

However, reports suggest that EmCare may practice balance billing out of network. Because their contractors are not employees of the hospital, they can allegedly charge out of network fees to emergency room patients who believed that, like the rest of the hospital, the emergency care was in network.

UnitedHealthcare says that EmCare is charging a 975 percent markup for emergency room fees. In comparison, Medicare charges a 297 percent markup.

The company’s persistent tendency for balance billing out of network reportedly lost it one of its major contracts and prompted a class action lawsuit.

In 2017, a woman filed a class action lawsuit after balance billing out of network left her with a $4,000 bill. She sought care at an in-network hospital which had an emergency department staffed by EmCare providers.

She assumed that her emergency care would be charged at an in network price but was shocked by her $4,000 bill – an amount that was allegedly four times the average in network price and double the average out of network price for the same services in that area.

“At the time of admission, EmCare made no effort to warn patients about what it knew to be true—that the emergency department physicians do not accept the same insurance as the hospital,” the EmCare class action lawsuit claimed.

This balance billing out of network plagues patients across the nation. Some patients are rushed to the nearest hospital for life-saving care, only to recover and be handed a hospital bill for hundreds of thousands of dollars due to balance billing out of network care. Others are referred to a hospital laboratory for testing only to find that their radiologist is not in network.

The possibilities are endless, but patients may be eligible to take legal action against companies such as EmCare for up charging their out of network services and not warning consumers that their services are out of network.

Join a Free Surprise Medical Bill Class Action Lawsuit Investigation

If you were hit with a surprise medical bill from an out-of-network doctor at an in-network hospital, you may be entitled to compensation.

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