Were You Hit With Surprise Medical Bills?

Have you been hit with surprise medical bills after coming home from the hospital—even when you thought the bill had been covered by insurance? Was your bill way higher than you expected it to be? You may have been affected by out of network charges. Being hit with surprise medical bills can have a huge financial impact on countless Americans and their families.

Recent research from the healthcare research firm Avalere showed that patients are now paying more for insurance with higher premiums, deductibles, and cost-sharing—but their networks have become more restrictive. This, in turn, increases the likelihood of being hit with surprise medical bills.

“This research confirms what patients and physicians across the country have known for some time,” said PFC President and CEO Michele Kimball, speaking to FierceHealthcare. “Insurers have been systematically narrowing their networks and increasing premiums, creating surprise insurance gaps that patients don’t realize exist until it’s too late. While insurers are making record profits, patients are paying more for less.”

What Are Surprise Medical Bills?

Insurance is a complicated issue, and the many without insurance are left to pay substantially more than they could possibly afford out of pocket. However, even when a patient has insurance, they may still face unexpected costs not covered by their insurance. Indeed, many medical expenses are not covered by some health insurance plans, and it varies depending on the insurance policy purchased.

Even when a patient thinks that their medical bills will be covered by their insurance, this may not actually be the case. While the hospital they were treated at may be in their insurance network, it is quite possible that certain doctors (often specialists) are considered out of network. A patient may not even be aware of this until they are later hit with surprise medical bills.

Not only are surprise medical bills an unexpected expense, but they usually cost much more than in network treatment. Out of network services are generally more expensive. Unfortunately, surprise medical bills can be financially crippling, amounting to thousands of dollars in surprise charges.

Surprise medical bills can occur for a couple of major reasons. One possibility is that the patient was, even briefly, treated by an out of network doctor (usually a specialist) at an in network hospital, who are brought in from outside the network for a specific purpose. This is common for anesthesiologists, and can sometimes include an emergency room doctor.

“Because they are not employees of the hospital, they use it as an opportunity to charge significantly more for your care and in some cases balance bill you for hundreds or thousands of dollars,” says the UnitedHealthcare website.

According to UHC, the physician contractor group EmCare overcharges patients emergency room rates three times as high as they should be—a 975% markup compared to Medicare’s 297% markup. UHC used to contract with EmCare, but announced in April that it was ending the contract due to “egregious billing practices.”

EmCare—along with its parent company, Envision Healthcare—was hit with a class action lawsuit over surprise medical bills back in 2017.

If you were hit with an out of network medical bill after thinking you were covered at an in network hospital, you may be able to file a lawsuit.

Join a Free Surprise Medical Bill Class Action Lawsuit Investigation

If you were hit with a surprise medical bill from an out-of-network doctor at an in-network hospital, you may be entitled to compensation.

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