After Hospital Visit, Some Patients Are Hit with a Surprise Medical Bill

By Joanna Szabo | June 15, 2018

Category: Consumer News

Hospital visits and the subsequent medical bills can be stressful enough. But some patients are finding themselves facing a surprise medical bill once they get home. These unexpected bills can occur if, at some point during your hospital treatment, you were seen by an out-of-network doctor.

Here’s the catch: this can happen even at an in-network hospital. Indeed, patients may find themselves bogged down with a surprise medical bill for thousands of dollars they didn’t expect to pay.

An $8,000 Surprise Medical Bill

One emergency room patient recently wound up with a $7,924 surprise medical bill, though his visit was to an in-network hospital, covered by his insurance. According to a recent article in Vox, he was taken to the emergency room in Austin, Texas, on Jan. 28 because his jaw had been broken in two places. He was taken in an ambulance while he was unconscious. But after he went back home, he ended up with a nearly $8,000 surprise medical bill.

The patient, Scott Kohan, says that he doesn’t know what he could have done differently to avoid the surprise medical bill, After he regained consciousness and was informed he would need jaw surgery, he checked to make sure that the hospital was in his insurance network.

“I was on my iPhone lying there with a broken jaw, and I go on the Humana website and see the hospital listed,” Kohan told Vox. “So I figured, okay, I should be good.”

What Kohan didn’t know—and what many patients aren’t aware of—is that just because a hospital is considered in-network, this doesn’t actually mean that all of the doctors who work there are considered in-network as well. In this case, the oral surgeon in the ER who treated Kohan was an out-of-network doctor. Because of this, Kohan’s health plan declined to pay that $7,924 bill from the oral surgeon.

But Kohan had very little choice in the matter. His jaw was broken in two places and clearly needed surgery. Moreover, he did what he thought he needed to do to see if this treatment would be covered, and found that the hospital he was at was considered in-network for his insurance. He, like many others, was not aware that an individual doctor might have different coverage requirements.

A surprise medical bill is most common with specialist doctors who may be brought in from outside the network for a specific purpose, like an anesthesiologist. Sometimes, even an emergency room doctor may even be out-of-network, like the oral surgeon in Kohan’s case. Ambulance rides often result in a surprise medical bill, as a whopping 51 percent of ambulance rides incur out-of-network charges.

Even when a patient believes their insurance has covered their hospital treatment, they may later receive an unexpected medical bill if some part of their treatment was not covered. Patients generally first find out that part of their treatment was out-of-network when they are hit with that surprise medical bill.

Adding to the problem of the surprise of out-of-network bills, the cost is usually greater because out-of-network doctors are generally more expensive in the first place, as they tend to be specialists. Unfortunately, a surprise medical bill can be financially crippling, and amount to thousands of dollars in surprise charges.

Sometimes insurance companies partially cover these surprise medical bills, but at an out-of-network rate, lower than what is provided through health insurance, leaving the patient to pay a far larger portion of the bill.

Filing a Surprise Medical Bill Lawsuit

If you were hit with a surprise medical bill after thinking you were covered at an in-network hospital, you may be able to file a lawsuit. A consultation with a medical billing attorney can let you know what your legal rights and options are.