How to Protect Yourself from Higher Than Expected Medical Bills

September 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care

If you are insured and visit your local emergency room at a hospital network in your area of residence, you expect to pay the stated co-pay that shows on your insurance card, right? This is, in some senses, a reasonable expectation, but it’s not always what happens. News media outlets around the country have aggressively broadcast many cases where huge out-of-network charges for secondary providers have led to excessive medical billing amounts for patients who simply visited the wrong hospital at the wrong time.

The Problem: Hospital Network Staff Outsourcing

This major problem, that results in more out of pocket dollars than expected, really has to do with how hospitals staff. Hospitals may simply bring in outside doctors, nurses, technicians and other staff who aren’t effectively on staff at that facility, in order to help fully staff an emergency room or other hospital department. This is a convenient fix for hospitals, but what’s enraging is the idea that hospital administrators don’t think about the dramatic impact that out-of-network charges can have on patients.

What happens with out-of-network charges is that when outside physicians or other staffers happen to provide care to a particular patient, that patient is simply billed for the balance of that care because of an automatic insurer denial. Insurance companies won’t usually pay for the work of out-of-network professionals, but hospitals hire them anyway. This is just one example of a typical disrespect for the financial needs of American patients, most of whom are never told about the possibility that they might pay out-of-network rates until they get a bill in the mail.

The Solution: What You Can Do

A groundswell of outrage has started and is leading many to question arbitrary hiring of out-of-network professionals by hospital networks that have contractual agreements with insurers. However, to date there has been no significant restriction of this practice, and no across-the-board policy for educating patients. What’s likely to happen is that patients who are proactive about their finances will start demanding information about out-of-network staffers as soon as they enter any department of a hospital. It’s a simple thing to make this demand, but whether the patient gets an answer or not depends on who is on hand at that particular time, although it’s also possible to write a letter to hospital administrators, either before or after the patient visits the hospital. We’ve said this many times: always get information in writing. In many cases, administrators or staffers will not be anticipating these questions. They don’t yet see that it’s only logical for patients to stand up for themselves, not just in selecting care, but in demanding transparent financial practices.

2 responses to How to Protect Yourself from Higher Than Expected Medical Bills

  1. What is also confusing and distressing for the consumer is when physicians bill their visit as a consultation, not an office visit. For some insurance plans, like my son’s college plan, consultations are not covered. If he had walked in off the street, instead of getting a referral from his PCP, the visit would have been covered. Seems you can’t win when you try to play by the rules!

  2. You are absolutely on point. There are so many variations and layers per each insurer’s plan that consumers have to be aware of.

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