Emergency Room Surprise Billing
For most people a visit to an emergency room carries sufficient stress. As many as twenty percent (20%) of emergency room patients receive additional trauma in the form of an unanticipated medical bill– in more than a few cases for thousands of dollars.
Patients who are forced to use the emergency services in a hospital, even one that is within their insurance network have a twenty percent (20%) of seeing an out-of-network ER doctor who may bill them for his services according to the New England Journal of Medicine.
The article was based on a sample size of over 2.2 million ER visits across the country and tracked by a large insurance company.
In many cases surprise billing often occurs when the ER calls in one or more specialists, such as a cardiologist or anesthesiologist. These specialists many not be employees of the hospital. Patients later find out that these specialists are not in their current insurance network and that their services may be a billable event.
This practice has been seen as “unfair and deceptive” by Senator Bill Nelson (D-Fla.) who has written to the Federal Trade Commission requesting their review of this practice.
There have been attempts a curing this issue by legislative means, including a bill introduced by
Representative Lloyd Doggert (D-Texas) that would have required providers to notify Medicare and Medicaid patients what the cost would be before they received care.
Under the current rules consumers must become their own advocate when entering the hospital through the emergency room. They or members of their family must document all conversations with the hospital staff as well as with their insurance carrier. Questioning specialists and even the attending ER doctor regarding their employment status and what insurance panels they are on is not unreasonable. Make sure the ER doctor knows who your insurance provider is and request that all services be provided through that carrier or someone in their network.