What Are Surprise Medical Bills?

Surprise medical bills can occur after a patient receives a service that is not classified as in network, despite thinking it would be.

What are surprise medical bills?

A “surprise medical bill” is any healthcare charge that occurs as result of treatment with an out of network provider. Emergency rooms and ambulance providers are the most common examples of surprise out of network charges. A surprise medical bill may also occur after receiving services from an anesthesiologist, radiologist, pathologist, surgical assistant, and other professionals or departments that are classified as subcontractors of a network.

Why do surprise medical bills occur?

According to The Commonwealth Fund, surprise bills may be the result of a practice known as “balance billing.” This term refers to situations where patients are required to pay the rest of a bill after insurance adjusts the amount.

If a doctor makes a claim to the insurance company, but the insurance company does not completely cover the charges, a doctor can then turn around and directly charge the patient for the leftover balance.

In some cases, providers or departments may not advertise their out-of-network status to patients. In these cases, patients may assume that their services will be covered at a typical in-network rate only to be surprised when their bill is returned with only out of network coverage.

How can I avoid unexpected medical bills?

The most obvious step patients can take to avoid medical billing surprises is checking in with their insurer, doctor and hospital before receiving treatment. According to the Wall Street Journal, by double checking that a service or provider is in network, patients may be able to avoid surprises when they receive their bill. Unfortunately, this may not be possible in emergency situations.

After treatment, patients should ask for an itemized bill and careful review the document for accuracy. This can help individuals catch items or procedures that were misfiled by mistake or in attempt to commit fraud.

Legislature in Congress is currently trying to help stop surprise medical billing. In May, a bipartisan bill was proposed by Frank Pallone and Greg Walden, the top Democrat and Republican representatives on the House Energy and Commerce Committee.

“We must ensure that patients are not responsible for these outrageous bills, which is why our discussion draft removes patients from the middle,” the two representatives said in a joint statement to Vox. “We look forward to receiving constructive feedback on ways to build upon our proposal, so we can advance a bipartisan solution that protects patients from costly surprise medical bills.”

The proposed bill would prohibit surprise medical charges that may arise from emergency care in a hospital’s emergency room. Additionally, it would provide protection from surprise medical charges that could arise if a certain provider at an in network hospital is classified as out of network.

“The Energy and Commerce draft is the strongest proposal at the federal level to date,” Loren Adler, the associate director of the USC-Brookings Schaeffer Initiative for Health Policy, told Vox. “It clearly eliminates the problem of surprise billing in both emergency and non-emergency situations.”

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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