Surprise Medical Bills Result from Unexpected Out-of-Network Care

Surprise medical bills may cause financial strain on patients who unknowingly receive treatment from an out of network provider.

Insurance providers often cover medical services based on whether or not a provider is considered in network or out of network. Hospitals and other facilities may be either in or out of network entirely, and these locations require little investigative work from the policy holder.

However, some emergency departments are managed by outside companies. In these cases, doctors employed by the emergency department management company may be out of network even if the hospital is in network. This can result in surprise medical bills if patients go to a hospital emergency room believing the services are in network when, in reality, they are out of network.

In certain cases, emergency management groups may take advantage of the lack of insurance coverage typically provided for their services. One physician contractor group, EmCare, has received widespread criticism for allegedly charging three times more than the standard rate for emergency services.

United Healthcare says that EmCare may charge a 975 percent markup on emergency room services. In comparison, Medicare charges a 297 percent markup for the same services.

These practices have prompted some consumers to take legal action against EmCare. One plaintiff filed a surprise medical bills lawsuit against EmCare after an emergency stay left her having to pay over $4,000 out of pocket.

The plaintiff had gone to an in network hospital under the assumption that the emergency department would also be in network.

“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 states.

She says the bill she received was a shocking four times larger than the typical in network bill for the same services in the same geographic area and twice as large as the typical out of network bill for the same services in the same geographic area.

Although the EmCare surprise medical bills lawsuit specifically mentions the issue of emergency room management, other issues may be the cause of large, unexpected charges.

Surprise medical bills may also occur for services conducted by a lab or other specialty doctor. Physicians who work in radiology or lab work are often contractors through a hospital, meaning that their coverage may not be the same as the hospital they work for.

Similarly, anesthesiologists who work with in network physicians during surgery may not be in network. These cases can result in surprise medical bills that patients are forced to pay out of pocket.

Regardless of why surprise medical bills occur, there may be deceptive actions involved. Consumers who find themselves faced with excessive surprise medical bills may have the opportunity to seek compensation through legal actions.

Attorneys are investigating a variety of practices and businesses to see if consumers have legal standing to seek compensation for deceptive practices resulting in surprise medical bills.

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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