Surprise Out-of-Network Bills are Higher than Expected

When patients stay in the hospital or visit the emergency room, they are often hit with surprise out-of-network bills that are much higher than they expected.

Insurance companies have contracts with both doctors and medical facilities for rates of service. As an insured individual, if you visit a doctor or a medical facility that is in-network, or has a contracted rate with your insurance company, you pay for your medical services at a lower rate.

If you visit a doctor or medical facility that does not have a contracted rate with your insurance company, or is out-of-network, then you pay a much higher rate for medical services.

The New England Journal of Medicine did a study that found that 22% of emergency room visits resulted in some kind of surprise medical bills and many of these are surprise out-of-network bills.

The rate was even higher in some states and this, the NEJM reports, is not just limited to emergency room visits.

In fact, what they found is that many of these surprise out-of-network bills from emergency rooms come because even though the actual emergency room is in a patient’s network, the doctor providing the service is not.

This often occurs when the insurance company has a contract with the hospital, but not the specialists providing services. Perhaps an anesthesiologist or a radiologist might provide services for a patient, but if these specialists are not contracted with the insurance provider, the patient will be faced with surprise out-of-network bills.

The Consumer Reports National Research Center reported that up to one-third of Americans have experienced some type of surprise medical bill at some point. They also found that those who had received such a bill don’t know how to address it or how to get help.

How to Avoid Surprise Out-of-Network Bills

There are many ways to avoid paying surprise out-of-network bills. They can occur even if you do your homework and research providers.

Forbes suggests the following if you get a surprise out-of-network bill.

• A bill you receive might not actually be an accurate representation of what you owe. Check to make sure your insurance hasn’t already made a payment on your behalf.
• Check with your insurance company to see if it is a mistake.
• Check with your insurance company to see if they have made changes to in-network and out-of-network providers.
• A medical facility you go to might be in-network, but the doctor you see may be out-of-network. You can ask if the doctors are in your network to avoid surprise out-of-network bills.
• Always ask if your treatment is covered in-network before you agree to it.

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!

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