Surprise medical bills can catch you by, well, surprise
Bottom line on top: If you’re the victim of a surprise medical bill, there are resources to help you.
After several years of the Affordable Care Act (ACA), many of us are resigned to high premiums, high deductibles and small provider networks.
We try to be good healthcare “consumers” (as if we really want to buy healthcare!) by reading the fine print on our insurance policies and making multiple phone calls to verify a doctor or facility is in-network.
We know the financial punishment could be HUGE if we don’t. Like what happened to this man in a recent article on Vox:
I went to a hospital where I am covered, and did everything I reasonably could do to confirm that I was going to be covered before having surgery….Unfortunately it didn’t work out the way.
In my opinion he was way more than reasonable in his attempts to stay in-network.
He was brought unconscious to the emergency department (ED) after being assaulted. He had a broken jaw and was about to undergo surgery. He also had a head injury. While lying on a gurney with a bloodied face, and no doubt in pain, he was pulling up his insurance information to make sure this hospital was covered by his plan!
Related post: How much does that ambulance ride cost?
And it was. Unfortunately, the oral surgeon who performed the jaw surgery later that evening wasn’t. (How was the patient “reasonably” to know this?)
The bill for that surgery came to almost $8,000, and because the provider was out-of-network, the insurance company denied payment.
Talk about being victimized twice!
Who to contact if you receive a surprise medical bill
There is good news and bad news, and it depends on where you live.
Twenty-one states have passed laws to limit or prevent surprise medical bills. Does your state? Check out the map and chart in this recent report by the Commonwealth fund.
Fifteen states offer partial protection, which mostly limits surprise medical bills from emergency department visits, like the story above.
Six states, including California and New York, offer more comprehensive protection.
Consumers Union, the advocacy arm of Consumer Reports, has a useful online tool if you find yourself the victim of a surprise medical bill. Select your state and it will give you a list of appropriate agencies to contact to help you appeal or negotiate down the bill.
My state, Washington, is one of the states that has no consumer protections for surprise medical bills. There’s been a bill floating in and out of the state legislature for several years, but it never gets passed.
If your state is like mine, consider contacting your state lawmakers and asking them what they are doing about this common and costly problem.
Or take it to the federal level. We deserve better than a patchwork of varying levels of financial protection.
Tips to avoid surprise medical bills
Read and understand your insurance policy before you need it. What is your provider network? Which hospital provides emergency services? What are your covered benefits? Which procedures (if any) require pre-authorization? Questions? Write them down and talk to a customer service specialist. It’s not possible to get all the facts and know all the answers beforehand, but it’s a good place to start.
Never go the the emergency department or hospital without a buddy! Surprise medical bills are most common following ED visits and unexpected hospitalizations. That’s an awful time to be worrying about what your health insurance will or won’t cover. Always bring an adult friend or family member with you to the hospital. Have that person be responsible for calling the insurance company (you may need to give verbal permission over the phone for the insurance rep to speak with your friend). Bring a notebook to document conversations with your insurance provider.
Related post: Hospital safety tips
Don’t be pressured to sign an insurance waiver form before you get pre-authorization. Many special procedures or diagnostic tests require pre-authorization. Sometimes a patient is scheduled for a surgery or procedure before the insurance company has a chance to authorize it, for example in the case of a cancellation opening up a spot in a surgeon’s busy schedule. To hurry things along (time is money in healthcare!), the patient may be asked to sign a waiver that basically says he or she—you—has agreed to accept any and all financial responsibility.
Surprise medical bills are a big problem and they are getting attention from state and federal lawmakers. You’re lucky if you live in a state that already offers some protection, although a lot of healthcare consumers don’t realize this and may pay an enormous medical bill without question and without seeking help.
The burden is on us, the patients, to be informed and take action to protect ourselves.
In addition to the resources provided by Consumers Union, check out An American Sickness by Elisabeth Rosenthal. Her highly-readable book on our broken healthcare system provides guidance and templates for fighting unreasonable or unexpected medical bills.