By Stephanie Stahl
PHILADELPHIA (CBS) — Having health insurance might not be enough to protect you from outrageous medical bills, even when you think you’ve made sure you’re “covered”. A growing number of people are getting surprise ER bills.
A trip to the emergency room is scary enough, but when the bills start arriving, you might feel sick all over again. It happened to Jamie Howard, who says, “It’s not right ..It is sneaky.” Jamie, who’s a tech manager in Philadelphia, had pounding headaches. He went to an emergency room for what he thought was a complication from a sinus infection. They did some tests, said he was OK, and sent him home with an antibiotic. “Four months later I get a bill in the mail. They told me I owed them a thousand dollars,” Jamie said. He had already paid his deductible for the hospital bill. He made sure he went to an in network facility, that would be covered by his insurance. He was shocked to find out the doctors in the emergency room were “out of network”. Jamie said, “Once you go in they tell you you got a deductible, you assume everything covered, nobody said the doctors were separate. They’re not actually employees of the hospital which blows my mind.”
A growing number of hospitals hire outside companies to provide emergency room doctors who often have their own arrangements with insurance companies. Patients get separate bills, both in and out of network charges. “It’s just not fair to the patients,” says Dr. Kelly Kyanko, a researcher at New York University. She did a study that found the problem of unexpected out-of-network charges affects an estimated three million Americans each year. Dr. Kyanko says, “No one ever thinks I’m gonna choose to see a doctor in an emergency that doesn’t take my insurance. That just doesn’t make any sense. So it really should never happen.”
“It’s called surprise billing so people tend to be surprised,” according to Antoinette Kraus director of Pennsylvania Health Access Network, which helps people navigate medical bills and health insurance. She says, “I think it’s hard to figure out. I think most of the folks that this happens to they don’t realize what the situation is or how they could even go about fixing it.”
“The parties involved do their best to make it confusing,” according to Jennifer Hopper who spent months trying to fix an out of network charge after her husband was hit in the face with a baseball. Craig Hopper said, “There was a lot of blood so there was a lot of concern. I don’t think there’s any reason why someone should believe that perhaps you’re about to see someone that is out of network because emergency care should be emergency care.” They made sure they went to an in-network hospital, covered by their insurance and were blind-sided when they got another bill for $700 from the emergency room doctors. Jennifer says, “I felt like it’s bait and switch. I felt like my in-network hospital was making promises to me that they didn’t deliver on.” Jennifer fought until the bill was fixed, which is what you have to do. Experts say it’s important to understand your insurance policy, ask questions, and carefully read your bills.
Different states have different regulations.
Pennsylvania Department of Insurance: http://www.portal.state.pa.us/portal/server.pt/community/file_a_complaint/9258
Pennsylvania Health Access Network: www.pahealthaccess.org
Delaware Department of Insurance: http://delawareinsurance.gov/services/filecomplaint.shtml
New Jersey Department of Banking and Insurance: http://www.state.nj.us/dobi/consumer.htm