Surprise Medical Bills Result from Scattershot Pricing of Treatments

A woman who suffered a miscarriage a year ago says the traumatic loss has been compounded by a series of surprise medical bills associated with her treatment.

Miriam Harper told CBS News that she was 12 weeks pregnant when she began bleeding, which prompted her to go to a local birthing center to be checked. She received two ultrasounds for which she was charged $150. She says she later went to a county hospital that same day because her bleeding worsened. The county hospital allowed her to return home, but in the early morning hours of the following day, she fell unconscious.

She then was taken to a hospital where she received two more ultrasounds — only this time, she was billed $1,500 for the diagnostic tests, not just $150. In addition, she’s received separate medical bills from the surgeon and from another facility.

The hospital did eventually waive her bills as the result of a financial assistance program, but the surgeon and the other facility still await payments.

CBS News found that prices for medical care can differ widely even in the same geographic region and when facilities use the same equipment. An MRI in Dallas and neighboring suburbs could cost $295 or all the way up to $5,323. A cardiovascular stress test ranged from $698 to $8,217.

Like any other business, hospitals need to make a profit. Billing restrictions for certain patients ant treatments may give hospitals a reason to increase prices elsewhere to maintain their revenue flow. Accusations have been made that hospitals raise the prices charged to private payers because the government’s Medicare system puts a lid on how much it will pay.

Surprise Medical Bills Top $650,000

CBS News also spoke to Frank Esposito of Long Island, N.Y., who thought he had been through the worst of it when he needed emergency back surgery that saved him from possible paralysis. A specialist ordered an MRI, which indicated Esposito had such a severe herniated area in his spine that a nerve could end up cut, paralyzing him. The specialist reportedly told him to go to an emergency room for emergency spine surgery.

CBS News found Esposito was told by his insurance company that the back surgery didn’t qualify as an emergency according to their terms, so they weren’t going to pay. The pain in his back nearly paled in comparison to the pain in his wallet when he found out the balance he owed was more than $650,000 in surprise medical bills.

Esposito says he felt he had no alternative but to hire a company that negotiated some of his medical invoices. Even after his balances were negotiated down, he still owed $220,000.

Esposito’s story on CBS News attained the attention of New York Governor Andrew Cuomo, who said nobody should face bankruptcy for seeking medical care. Yet bankruptcy is a predicament Americans have faced in recent years.

After the story ran, Oxford United Healthcare informed CBS News that Esposito will need to pay his normal co-pays, but that the insurance company will pay the remainder of the outstanding claim.

Even though he’s relieved he’s not on the hook for hundreds of thousands of dollars now, he told CBS News it “shouldn’t be this difficult.”

States Institute New Laws Regulating Out-of-Network Charges

Several states are attempting to change the laws regarding surprise medical bills and out-of-network services. A new state law that took effect in Washington on January 1 will protect consumers from being billed premium prices for services received at out-of-network hospitals or by out-of-network physicians.

Under the new law in Washington, state and public school district employee health plans, individual market exchange plans, and employer plans purchased directly from health insurers will be prohibited from charging consumers higher prices for out-of-network providers.

Additionally, large employers that self-fund their health plans can opt-in to the law if they choose. So far, more than 150 employers have chosen to opt-in and protect their employees from surprise medical bills.

Under the law, people with state-regulated health plans who are taken to out-of-network hospitals for mental health, substance abuse, or medical emergencies will be charged fees comparable to their in-network providers.

Additionally, the law provides Washington residents with an avenue to dispute any incorrect out-of-network bills. Consumers who are hit with surprise medical bills will be able to contact the out-of-network provider or facility that sent the bill and inform them of the incorrect charge. The law also allows them to file complaints with the insurance commissioner’s office, and details an arbitration process to resolve disputes between consumers and insurance providers.

In addition to the new law in Washington state, Kansas legislators are also considering instituting a similar bill.

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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This article is not legal advice. It is presented 
for informational purposes only.