Surprise Medical Bills

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medical-billing-advocate_93837676How can someone receive a medical bill they were not expecting? This might seem unlikely, but actually, this is occurring more and more. Patients across the U.S. are receiving bills from physicians that their health insurance will not cover because that doctor is not in their health insurance network. More fortunate patients might have an insurance plan that will cover a small portion of the bill, but those patients will be responsible for the majority of the billed amount.

You would expect this if you had received care at a facility that is not included in your network, but this is occurring much more frequently in hospitals and facilities that are part of a health insurance plan’s covered network. How does this happen?

Hospitals and other medical providers are allowing non-contracted physicians to practice within their facilities. These non-contracted physicians are almost never part of a health insurance’s covered network. Often, these physicians are surgeons, radiologists and anesthesiologists and it’s not unusual for the patient to have never even met this healthcare professional. Imagine that patient’s surprise when he or she opens a bill for an exorbitant amount from a doctor he or she has never even met. Most likely, that patient was not expecting an additional bill at all.

You will likely never meet the radiologist who reads the results of your x-ray. The anesthesiologist might have a nurse anesthetist actually give your anesthetic. How, then, would you be able to question them about their participation with your health insurance company? Even if you did briefly speak with one of these healthcare professionals, would you know to ask them if they participate in your health insurance network? Most likely, you would be under such distress with facing surgery or from the ailment that brought you to the hospital, you would not have the wherewithal to ask this question. In the event that you are unconscious, you would have no way to attempt to protect yourself from being seen by an out-of-network provider.

This begs the question: How is out-of-network billing within an in-network facility fair? The simple answer: It’s not. But there are ways you can try to protect yourself from this unfair billing practice.

If you have the luxury of knowing that you will have a procedure ahead of time, make it known to whomever is handling your care (physician, physician assistant, etc.) that you do not want to receive care from anyone who is not contracted with your health insurance network. When possible, get a statement in writing that is signed by an appropriate member of facility staff that states this information.

The most frightening thing about surprise medical bills from an out-of-network provider is that many times, there are no real ways to protect yourself ahead of time, unless you have a signed statement from the facility. However, Medical Billing Advocates of America is here to help you fight for what is fair and reasonable. Call us if you are the victim of an out-of-network hospital bill at 855-203-7058.


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