Why Emergency Rooms Are A Hotbed For Surprise Medical Bills

Why Emergency Rooms Are A Hotbed For Surprise Medical Bills
November 05 01:00 2015

Why Emergency Rooms Are A Hotbed For Surprise Medical Bills

When you head into the emergency room, you might assume that the doctors you see are hospital employees who accept the same insurance plans as their employer. But nearly two-thirds of hospitals now staff their ERs with freelance physicians who might not accept your insurance plan, meaning you’ll be on the hook for whatever your insurer doesn’t pay. In addition to the potential added financial burden, some patients now have to drive far out of their way to find an ER that won’t hit them with a surprise medical bill.

Melanie*, who lives in California, is one of these patients. After a series of surprise bills from out-of-network ER doctors at otherwise in-network hospitals, she realized the only way to avoid the unexpected sticker shock was to look outside her area for emergency care.

“I know that our local hospital doctors do not contract with my insurance,” Melanie tells Consumerist. “I was having chest pain for several days, and chose to not go to the local hospital but to go to one farther away because I had run into issues at the local hospital with balance-billing.”

As we’ve discussed before, “balance-billing” is the practice by which out-of-network doctors will bill patients for the balance that remains after the insurance companies pays out its contractually obligated amount to the hospital.

In California, your protection against balance-billing depends on which type of plan you have and who regulates your insurer. Consumers covered by HMOs and PPO insurance plans licensed by the California Department of Managed Health Care are protected from balance-billing for ER visits.

But if the PPO or any other insurance plan is regulated by the California Department of Insurance, state law does not protect an ER patient from balance-billing.

This inconsistency in California law leads to some patients erroneously being billed for balances that their HMO should be negotiating. But if you’re like Melanie and your plan is not exempt from balance-billing, it’s up to you to either pay up or try to work out a deal with the doctor…

Read full story at The Consumerist
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