A car accident, fall or heart attack. You never know when an emergency will hit. Surviving the tragedy is often followed by another – this one financial.
Most of us now have health insurance, but that doesn’t always mean a person is covered.
Danny and Linda Postell checked with their doctor and hospital before their son Luke was born to make sure they were both still part of their health insurance network. The Postells had used the services three years earlier when their son Jack was born.
Everything seemed alright until Linda’s water broke three weeks before her due date. She was rushed into surgery. Her son was not breathing at birth.
Luke is a perfectly healthy and happy toddler now, but before coming home, he had to spend nearly two weeks in the Neonatal Intensive Care Unit before coming home.
“It was really tough. He was only there 12 days but it seemed like forever,” said Linda.
As unexpected as the complications with Luke’s birth, were the medical bills. Turns out, the specialist that treated Luke in the NICU was a contract employee and not a part of their network.
“They use him for all their services, but he doesn’t work for that hospital. Yet he’s overseeing all the care for your NICU or specialized care,” said Danny, amazed that this was how the medical system worked.
It happens all the time, usually with contracted employees, from specialists to surgical assistants.
“That could be an anesthesiologist group, it could be radiologists that read MRI’s or CT scans. It can be pathology groups that do lab work,” said Beth Stephens, the Health Access Program Director for Georgia Watch, a consumer advocacy group.
Not only do patient’s get stuck paying a higher co-pay because the provider is out of network, but for many the payment will count against a different deductible. There is also the problem with balance billing. In-network providers agree to perform the service for a pre-set price. Out-of-network providers have no such deal. That means patients are on the hook for a much larger bill.
For the Postell’s that unexpected charge initially added up to more than $4200. They want to know why no one at the hospital said anything to them when they crossed that invisible line between covered and not covered care.
“Is there a line, is there a point where you do cross that line that you tell us? Or is that ignorance on our part because we don’t ask?”
Even if you do ask, many hospitals and doctors are hesitant to answer and if you’re rushed in for care – there's no time.
A survey by Consumer Reports says 41-percent of Georgia residents have found a surprise medical bill in the past two years.
“Medical debt is the leading cause of bankruptcy,” said Stephens. “(It) can be devastating to a family. I mean thousands of dollars of unexpected medical costs in a year can really have an impact to afford other necessary items.”
This year Senator Renee Unterman introduced one bill to address the problem – and another to study it. While nine states have passed some kind of surprise medical billing protection for patients, Georgia lawmakers will only commit to looking further at the issue. (see map) On a federal level, Congressman John Lewis is co-sponsoring a bill titled “End Surprise Medical Billing.” It has yet to make it out of committee.
“Common sense isn’t common anymore, as much. Things I would have thought would be handled and taken care of, it almost seems why not?” questioned Postell.
Surprise medical billing is not new, but Stephens says it is certainly getting more attention right now. She believes that’s because under the Affordable Care Act, more people have insurance. Combine that with the shift to high deductible plans and more people are giving these statements a close look.
Georgia’s Department of Insurance recommends patients researching an upcoming procedure take a photo of their directory, showing that the doctor and hospital are in their health insurance network. Obtain prior authorization in writing for the medical service. Before paying a balance bill, contact your health plan and the provider to see if either will help resolve the bill. If that doesn’t work, you can file a complaint with the Department of Insurance by going to www.oci.ga.gov or by calling 404-656-2070.
Beth Stephens of Georgia Watch took part in a Facebook Live chat to answer questions from viewers. Watch the discussion below (you may want to turn the volume up on your computer):
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