As nurse patient advocates and insurance advocates here at Healthlink Advocates, we get regular calls from people shocked by an unexpected and often very large surprise medical bill. We have had clients call about a $500,000 air ambulance bill. A $450,000 hospital bill after the patient paid $90,000 upon admission and was told that there would be no further costs.
Medical Bankruptcy
It is no wonder that medical bills are the number one reason for bankruptcy in his country. I won't even go into the number of errors we uncover in an in-depth bill review. Let's focus on surprise bills. These are bills from out-of-network providers. A typical scenario is you need surgery. You do your due diligence and ensure that your health insurance will cover the hospitalization and the surgeon. You find out that the hospital is in-network. What does in-network mean? It means the hospital, doctor or provider has contracted with your insurance company to accept a certain negotiated (i.e., discounted) rate.
You didn’t think to ask whether the anesthesiologist was in-network. You never knew there could be an out-of-network provider in a hospital that is in-network. Just an FYI, anesthesiologists are not usually in-network. This means that they do not have a contract with your health insurer and did not agree to a discounted rate. They believe that the “discounted” rate is too low to provide the quality care that they provide.
Surprise!
Then you receive the surprise bill from the anesthesiologist which, can be thousands of dollars that you are responsible to pay in full. Out-of-network providers can charge any fee. Things are looking up! There is hope on the horizon with a bill in Congress to ban this type of billing.
Ban on Surprise Bills Legislation
In a bipartisan effort, Congress is trying to pass a bill to ban these surprise bills. In a December 8, 2019, NY Times article by Margot Sanger-Katz, she reports that leaders of key Senate and House committees have agreed as to how to eliminate these surprise bills. It may be a bill that passes by the end of the year. The bill would prevent doctors from sending unexpected bills to patients when they are treated in a hospital that accepts their insurance. Further, it would establish a system for resolving related billing disputes between doctors and insurance companies. The article is worth the read to find out some additional information about “dark money groups” involved and the underlying details. https://nyti.ms/36krM0C. Here is another interesting article. http://bit.ly/2RAtvLh
We are pleased that the vulnerable patients we speak to everyday, who find it so difficult to understand the healthcare system, are now getting more protection from these overwhelming surprise bills that oftentimes lead to financial ruin.
Hot Off The Press
I was about to post this blog and just this morning read a new development in this bill. The House Ways & Means Committee has proposed a new bill and is calling for a delay. So just when you think this bill may pass by years end, a new bill shows up causing a delay. Details of this proposed bill were not detailed but this just may cause the delay of the passing of the original bill by the end of 2019. Stay tuned.
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