Imagine attending an emergency room in a hospital covered by your health insurance. You believe your care has been covered by your medical insurance. However, weeks after you receive an astronomical bill for the procedure. Thousands of people struggle with this problem daily.
These are surprise bills, charges or bills that arise when an insured individual inadvertently receives care from an out-of-network provider. One in seven patients that visit the emergency room, according to the Harvard Global Health Institute. In fact, around 99.6 million insured people received surprise medical bills in 2015.
Most of these surprise bills are a result of “hidden” or “invisible” providers, medical providers that the patient had little to no choice in using, and often are unaware their services were used. “It’s often a provider, like a pathologist or anesthesiologist, who reads or interprets a test or is a part of a larger care team, but not the main provider”, explained an article by the Pennsylvania Health Access Network.
The case of LeeAnn Tiede
That was the case of LeeAnn Tiede, an American woman who underwent a breast cancer procedure. Before the surgery she researched extensively the status of her hospital and surgeon, to ensure that these entities were covered by her medical insurance and were in-network. However, weeks after the procedure she received an extremely expensive bill for the procedure. It turned out the anesthesiologist that treated her was out-of-network. Tiede’s case acquired notoriety, and shone light on the surprise bill problem when Patty Murray, a member of the Senate Health, Education, Labor and Pensions Committee, investigated her case and used it as an example to reinstate the importance of finding a solution.
Presently, various states, such as New Jersey, New Hampshire and Virginia have taken note on the issue and are working on solving the surprise bill issue and protecting the patients. Legislators in these states are drafting different bills such as preventing consumers from being held responsible for unexpected out-of-network bills if they are treated at an in-network facility, among others. Nonetheless, it takes time to approve and implement these legislation.
On the other hand, Centers for Medicare and Medicaid Services (CMS) is trying to tackle the surprise bill issue through policy. It will require hospitals to publish a public online list of standard changes that would be updated annually, and patients should be informed of their out-of-network costs for a service before it is executed.
3 tips to handle surprise bills
Yet, there are no practices or rules in place at the moment, and patients can’t foresee when they will receive a surprise bill, so here are a few tips to prevent and deal with them:
- Use innovative technologies, such as the mobile app Claimeye, to submit out-of-network or surprise bills, to your medical insurance and get reimbursed without having to deal with anymore stress or hassle. A patient simply takes a picture of the insurance card and the receipt Claimeye will handle the rest.
- When possible, use provider directories and other plan-provided information to locate and verify in-network providers.
- If providers are out-of-network, ask whether they will accept the plan’s payment as payment in full.