If you’re like many others who thought that going to an in-network ER meant you would only be charged in-network fees for services, you could be in for a nasty surprise when the bills begin to come in. Consumerist.com published today an article titled: Insurance Loopholes & Master Pricing: How Surprise Medical Bills Knock Consumers Down. The articles walks consumers through some of the basics of health insurance and the healthcare industry today, but it also contains some information that may save consumers serious sticker shock down the road. For example:
While the idea of in-network and out-of-network might is fairly straightforward — you’ll pay more going to an out-of-network provider because he or she simply isn’t covered by your insurance — healthcare providers sometimes present patients with situations where part of the care is covered and part is not.
For example, you may go to an in-network hospital for surgery, only to find out that somewhere along the way, the hospital brought in another doctor — many times, it’s the anesthesiologist — or used a lab, or hired an outside consultant, that is out-of-network. This is often done without notifying the patient, meaning they won’t know until they get their bill that their insurance will not cover all of these particular costs.
And even if your insurance provider will agree to pay some amount to these out-of-network providers, they can still come after you for the balance.
“Your financial responsibility for a given charge is going to vary widely based on your specific treatment,” Julie says.
Has this ever happened to you where you’ve received surprise charges after a hospital stay or emergency room visit? We’d love to hear about it.