Surprise medical bills

Some friends of ours had to sell their beautiful home because of a surprise medical bill. The husband had a heart attack while kayaking and was taken by ambulance to the nearest hospital. But the hospital turned out to be “out of network”: it had no contract with my friends’ insurer. I don’t know what my friends paid for the medical care, but I read about a patient who was charged $500,000 for ten weeks of dialysis treatment in an out-of-network facility. Maybe that person lost his or her home also.

In negotiating contracts, hospitals select insurers that give them the best rates and have the best reimbursement history. But physicians at the hospital may not be in the network. Sometimes they choose not to participate in any networks at all. They can charge whatever they want, but you might not know this. You might choose a hospital and surgeon who are in your insurer’s network but discover too late that the participating anesthesiologist and radiologist are not.

A new study showed that surprise bills can be anywhere from 118 percent to 1,382 percent higher than what Medicare is billed for the same services. In 2017, about one in six Americans were surprised by a medical bill after treatment in a hospital—despite having insurance. On average, 16% of inpatient stays and 18% of emergency visits leave patients patient with at least one out-of-network charge. Most of those came from out-of-network doctors offering treatment at the hospital, even when the patients chose an in-network hospital. Insurance companies agree to pay a portion of the non-participating doctors’ bills. The patient pays the rest. Surprise!

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