Are you being over-billed for surgery?

Emergency Medicine

11 Apr 2020 | 1 | by kjh

11720login-checkAre you being over-billed for surgery?

Surgery is stressful enough but what happens when you receive your bill and it’s thousands of dollars more than you expected?  That’s what happens to a lot of people. For example, you might check ahead of time and find out that your surgeon is “in-network” with your insurance company. Later, when you receive various bills from doctors who were involved with your surgery you might find out they were “out of network.”  That means that some of the doctors involved with your care can charge you “out of network” pricing and it can be astronomical.  That happened to me when my son had surgery. When I received the bill from the anesthesiologist it was huge. I called the doctor’s office and refused to pay the out of network price so they agreed to bill me the amount it would have been if they were “in-network” with my insurance company.  It was a huge difference. The doctor’s office said they would lose money but I was never given a chance to choose a doctor who was in-network.

Many people are not so fortunate.  The doctors refuse to lower the bill and threaten to send it to a collection agency.  Congress members have started hearing complaints about “surprise medical billing.” The House Energy and Commerce Committee introduced a bill called the No Surprises Act.  It would require medical providers to give patients twenty-four hours notice if they were going to be treated by a medical provider who was outside their insurance network and would restrict how far above the median price out-of-network providers could charge. Senators introduced a similar bill, called the Lower Health Care Costs Act, which included an arbitration provision that would help manage disputes over how much out-of-network providers would be permitted to charge.

The question is when we will actually see a bill that is passed that abolishes surprise billing.  As more people are rushed to the hospital for treatment, we might see more surprise billing until something is done about it.

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11 months ago

California passed a surprise billing law, AB-72. protects consumers who use an in-network hospital or other facility from being hit with surprise bills when cared for by a doctor who has not contracted with their insurer. If that happens, consumers are responsible only for the copayment or other cost-sharing that they would have owed if they had been seen by an in-network doctor.

Nearly 90% of the doctors said that the law allowed insurers to shrink physician networks, thus limiting patients’ access to in-network doctors. Physicians blame the new law’s reimbursement rates for surprise out-of-network care. Consumer rights groups disagree.
It’s a debate that the federal government is looking at to see how it works.

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