What Should I Do if I Receive Surprise Out-of-Network Medical Bills?

Most insured Americans know that they must visit providers and facilities that are considered “in-network” with the insurance company in order to make the most of their health insurance coverage.

Before an emergency arises, or before an important planned surgery, insured individuals usually know that certain hospitals offer in-network coverage and are a preferred location to have and surgical services performed based on the insurance plan. However, a recent study showed that up to a third of patients may be the recipient of surprise out-of-network medical bills for hundreds or even thousands of dollars.

The survey, undertaken by the Consumer Reports National Research Center in March 2015, reviewed data from 2200 U.S. residents who held private medical insurance. Of the one-third of survey respondents who received surprise out-of-network medical bills, one-fourth of them received a bill from a doctor that they had no idea was out of network provided them care.

How does something like this happen when a patient visits an in-network facility? While most doctors working at an in-network facility are in-network, some doctors and medical support personnel are routinely out-of-network, such as anesthesiologists, radiologists or ER surgeons. However, patients are typically not made aware of the doctor’s insurance network status, so this results in surprise out-of-network medical bills.

How Should I Deal with Surprise Out-of-Network Medical Bills?

It may not be possible to preemptively avoid all surprise out-of-network medical bills, but doing your due diligence as much as possible beforehand could put you in a better position to deal with these issues.

If you have already received surprise out-of-network medical bills, you can still take appropriate action to address them. MarketWatch lists four main strategies to help:

Obtain Insurance Estimates for Elective or Planned Surgeries

If you know ahead of time that you are going to have surgery, you can find out the precise medical name for the planned procedure you will be undergoing and its associated CPT billing code, as well as any related diagnostic codes.

Any procedures or testing that is to be done before or after surgery should also be part of your information gathering. You should also ask if any members of your healthcare team, such as anesthesiologists, radiologists or assistant surgeons may be out-of-network.

Once you have this information, you can contact your insurer for a detailed insurance estimate to get you an approximate dollar amount. If your bill following the surgery contains costs not previously explained, you can work with the insurance company to understand these costs, and having prior knowledge and an estimate can help you in negotiating to pay a lower price on your medical bill.

Obtain Information about In-Network Emergency Services

Before an emergency arises, individuals can contact their insurance plan to find out which local hospitals are in- network in which hospitals are out-of-network. Additionally, since emergencies can happen anywhere, it’s a good idea to find out you’re out-of-state insurance coverage.

You may not be able to find out the status of all the doctors and medical personnel, but at least going to end in-network hospital can help you avoid surprises when your bill arrives.

Take Action After Receiving Surprise Out-of-Network Medical Bills

Sometimes, surprise out-of-network medical bills are the result of a billing or clerical error. It’s important to start with the insurance company first to try and sort out any issues. Then, you can contact the provider directly to see if you can negotiate the costs to pay a lower rate or you can set up a payment plan with the provider.

If the costs in your surprise out-of-network medical bills appear unfair, you may be able to file a formal complaint with the insurance company after checking to see what type of projection your state offers with respect to surprise medical bills.

Be sure to keep detailed and accurate documentation of your complaint. You may also be able to file a formal complaint directly with the division of insurance in your particular state.

Keep Your Doctor Informed of the Surprise Out-of-Network Medical Bills Situation

it’s important to keep your doctor informed when you are disputing a bill. You can request that the provider not submit your bill to a bill collector, which can damage your credit. Doctors are currently not required to follow your request, however, keeping the lines of communication open are in your best interest.

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!

Get a Free Case Evaluation Now