Miami lawmaker pushes bill to ban unexpected medical charges for emergency services

November 02 01:00 2015 by ushadmin

Like most patients, Robert Delfino did what his doctor told him: Go to the hospital for an outpatient cardiac procedure to determine the cause of his heart condition.

Delfino, 54, was following the advice of his cardiologist, listed in his insurance company’s provider network catalog.

Fortunately for Delfino, of Delray Beach, his coronary blockage was not serious enough to require a stent. The real problem came two months later, when Delfino received a bill for $15,000 from the hospital, which was not an in-network provider.

Delfino was incredulous. A self-employed real estate appraiser, he had bought his health plan on the Affordable Care Act exchange at healthcare.gov.

“I thought my in-network doctor would take me to a network facility,” he said. “I thought the insurance company would call me if it was out of network.”

Delfino’s experience is an increasingly common one known as “balance billing,” or the unexpected charges patients receive for medical services from a doctor or hospital that does not have a contract with the patient’s insurance plan. In such cases, the consumer ends up owing the difference between what the insurer chooses to pay and what the doctor or hospital charges — although one Miami legislator is aiming to change that…