Health Care Balance Billing Leaves Patients with Unexpected Medical Bills

Patients fighting health care balance billing finally believe the federal government might be paying attention.

President Donald Trump recently hosted a gathering of doctors and patients who shared their experiences of receiving outlandish medical bills, despite in many cases, believing they had done due diligence to ensure they had sought in-network care.

Both Democrat and Republican lawmakers have expressed that surprise medical bills are an unacceptable financial stress faced by many American families and have vowed to put a stop to the often outrageous invoices.

Still, lawmakers expect to face opposition from insurance companies and doctors over who is going to be stuck with paying the bills.

Currently, most patients with health insurance make every effort to go to an in-network provider for their care. The in-network providers have negotiated rates with an insurance company, which enables the provider to be in the insurance company’s covered network.

Despite seeing an in-network provider or going to an in-network hospital, patients can’t seem to escape the risk of receiving surprise medical bills. In many cases, the patients are victims of balance billing, which is the difference between the amount the insurers pay and the list price at the doctor’s office or hospital.

According to NPR, one patient who attended President Trump’s meeting said she received a $17,850 bill for a urine test that was required after she underwent back surgery. Elizabeth Moreno is the daughter of a retired doctor from Ohio.

As a college student in Texas, she needed spine surgery to correct excruciating back pain. She told lawmakers that she made sure she saw an in-network provider. Her urine sample, however, was tested by an out-of-network lab in Houston that sent her the bill for nearly $18,000.

Elizabeth’s dad said he paid the lab $5,000 because he didn’t want his daughter’s credit rating to suffer, but he also filed a complaint with the Texas attorney general, calling the lab’s invoicing “price gouging of staggering proportions.”

Reasons for Health Care Balance Billing

In Elizabeth’s case, an in-network doctor allegedly sent her urine sample to an out-of-network lab. Even so, the charge of more than $17,000 for a urine test seems to be out of line with the average $200 cost for such lab work.

In another case reported by the New York Times, a college professor needed emergency gallbladder surgery. He admits he did not confirm whether or not the hospital was in-network because he was in excruciating pain and was actually called back to the hospital hours after he was sent home with pain medication once the lab results came back.

He and his insurer paid $11,000, and he thought that was the end of it. He was surprised to receive a follow-up invoice of almost $8,000 later, which the hospital said was required to be paid because it was not in his network.

The professor says his insurance company is Cigna, which created a formula to determine it would pay about $11,160 because that is similar to what Medicare would pay. The hospital is insisting the professor pay an additional $8,000, and he is continuing to try to negotiate with the hospital to see if it will settle for less.

In another case reported by Consumer Reports, a woman who had scheduled a C-section was told her scheduled anesthesiologist could not make it. The doctor who filled in for the missing anesthesiologist was not in-network. The woman and her husband received a surprise medical bill of nearly $15,000.

A couple of different bills have been proposed by lawmakers to help consumers reduce the unexpected hassles of health care balance billing.

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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