Surprise Out of Network Medical Bills Cost Consumers

Have you been hit with surprise out of network bills despite thinking you were covered by your insurance company? Consumers may find that they are faced with a far higher hospital bill than expected because of specific doctors that are in a different network from the facility itself.

Surprise out of network medical bills can occur when a patient is treated by a provider outside of the network covered in their health plan, incurring higher charges. For instance, an emergency room doctor or specialized doctor like an anesthesiologist assisting with a surgery may be out of network, even when the main doctor is not. Patients may then be hit with surprise out of network medical bills after they’ve gone home.

A substantial percentage of patients are hit with surprise out of network medical bills. Two recent nationwide studies looked at this issue, published in Health Affairs and The New England Journal of Medicine. Both studies found that 20 percent of patients treated during emergency room visits and subsequent hospital admissions, even at in-network facilities, would also be treated by an out of network physician at some point and would incur extra charges. Ambulance rides led to even more surprise out of network medical bills—around 51 percent are out of network.

Unfortunately, these kinds of surprise out of network medical bills can be considerable. In New Jersey, for example, surprise out of network medical bills cost patients $2,500 on average—or $420 million total per year.

The average out of network medical bill varies from state to state. According to study out of Yale, which looked at millions of emergency room visits all across the 50 states, some places had significant out of network medical bill fees. Others had next to none, which researchers said indicated that this is an issue that can be solved.

According to a study from the Yale School of Public Health and the Yale School of Management, the average out of network medical bill comes to more than $622. This is the kind of unexpected fee that can cause serious problems for some patients. Others are hit with an even larger out of network medical bill of thousands of dollars, which can be financially crippling. In at least one case, a patient ended up with over $19,600 in surprise out of network medical bills.

It can take some time after an emergency room visit or hospital stay for patients to even find out about surprise out of network medical bills.

While insurance companies sometimes partially cover surprise out of network medical bills, they do so at an out of network rate, which is much less coverage than what patients expect from a hospital covered by their health insurance. The patient is then left to pay a far higher portion of the bill. On top of this, out of network doctors are usually paid significantly more than those that are in-network. Indeed, out of network doctors are, on average, paid 2.7 times more than in-network doctors.

If you were hit with surprise out of network medical bills after being treated at an in-network hospital, you may be able to pursue a lawsuit for compensation.

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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!

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