Surprise Medical Bills: What You Need To Know

Posted in Personal Injury on June 2, 2016

When you are injured in a car wreck or other accident, the last thing you think is “I better go to a doctor that is covered by my insurance.” Unfortunately with insurance companies becoming less pro-patient and more pro-profit keeping this question top of mind is not your first priority if you’re hurt – but it could save you a lot of money.

Recently, the Tennesseean published an article about an injured patient that was advised to attend an Emergency Room for back pain. He did his due diligence and ensured that the ER that he was going to visit was “in network” and covered by his health insurance. However, what he did not realize was that the ER Doctor that attended to his care was “out-of-network”. After all was said and done, there was $1,900.00 owing in medical bills. How did this happen?

Many health insurance providers make deals with health care facilities and providers to be in the “network” of that insurance company. This means that services provided by those facilities or practitioners will be covered by the insurance. An “in-network” doctor provides these services to a patient and the insurance company pays the insured portion of the bill with the patient receiving a reduced bill.

Where the problem arises is the disconnect between health facilities (the hospital) and health providers (the doctor, nurse, anaesthesiologist or surgeon). A health provider at an ER is not required to belong to the same “network” that the hospital is in. So, for example if Insurance Company X is in agreement with Nashville General Hospital, the hospital is in X’s network and hospital bills will be covered – or at least reduced- by X. BUT, a doctor at Nashville General Hospital does not have to be in X’s network so the services that the doctor provides will not be covered or reduced by X. The result – you will receive a bill from the hospital for use of the ER that is reduced by X and then you will receive a full cost bill from the Doctor for health care provided. These full cost bills are called balance bills and are being referred to as “surprise bills” and according to the Tennessean article, they are drawing the attention of advocates and legislators across the country.

Although health facilities encourage their doctors to belong to the same network as the facility, they are not required to. This health industry practice is putting an onus on patients to find out who is providing their medical care prior to receiving it.

As personal injury and social security disability attorneys we deal with medical bills and insurance companies on a daily basis. If you are injured in an accident we can help you talk to your insurance company to make sure you have all of the information on your health care network. Trusted Tradition. Authentic Attorneys. Real Relationships, Larry R. Williams, PLLC Attorneys At Law.
Call us today for your free consultation 615-256-8880.