Surprise Medical Bills May Occur After ER Visits

Sometimes, patients can be hit with high surprise medical bills even when they are seen in a hospital that is covered by their insurance plan. Patients have reported receiving surprise medical bills in the mail, in particular after emergency room procedures.

When an individual is injured and requires emergency services, most of the time they attempt to visit a hospital that takes their insurance. Emergency room bills can be high, but insurance covers many procedures and services if the hospital is an in-network facility.

However, a recent problem has come to light regarding patients receiving surprise medical bills from hospitals covered by their insurance. One New England Journal of Medicine study found that in about 22% of emergency room visits, patients are hit with out-of-network, surprise medical bills.

When your doctor and hospital are in-network, they have an agreement with the insurance company to provide services at a lower rate to patients. Most patients visit doctors and hospitals that are in-network so that they only need pay their co-pay, or agreed-upon rate, for visits.

Sometimes, during emergency room visits, the hospital is considered in-network, but the emergency room physician is not.

The patient neither has knowledge or control over whether or not an emergency physician they are seeing is in-network for their insurance or out-of-network. The doctor may treat their ailment in an in-network hospital, but may charge the patient out-of-network fees for their services.

The New York Times tells the story of one man who became ill while out of town at a professional conference in Florida. He tried to find an urgent care center, but was unable. He called his insurance company on the way to a local hospital emergency room and his insurance company assured him his visit would be covered.

The attending doctor ran some tests and gave him some medication, the article reports, and released him.

About a month later after he had returned home, he received a bill from the emergency room doctor for $1,620–an out-of-network surprise medical bill for the emergency services he received when he was in Florida.

He was unaware that the physician treating him was out-of-network even though the hospital was in-network.

An assistant professor of health policy at Yale, Zach Cooper, told the Times that once a patient is seen in an emergency room, he or she has very little control over what doctor assists them. Cooper said, “To put it in very, very blunt terms: This is the health equivalent of a carjacking.”

He believes that Congress could do something about this by requiring hospitals to offer an “emergency package” that would bundle the services of both the doctor and the hospital together so no patients would get stuck with surprise medical bills.

This type of surprise medical billing takes place when the insurance company reaches an agreement with the hospital but not the individual doctors. Many believe this practice is unfair and deceptive. If you or someone you love has experienced surprise medical bills, you may be entitled to legal compensation.