What to do if you got a medical surprise bill

According to a University of Chicago survey, at least 57% of Americans have received an unexpected medical bill. We are talking about “surprise bills” for medical care that was not covered by insurance. In this case, the patient is not guilty of anything, but must pay money - sometimes tens or even hundreds of thousands of dollars. What should you do if you receive such an invoice?

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“Surprise bills” can really shock you. A Texas man received a bill for $108 after he was taken to an out-of-network hospital after suffering a heart attack. A skier from Vermont paid $951 for help after breaking her leg on a mountain slope. An expensive urine test was also recorded - the patient received a bill for almost $18 for having it done in a laboratory whose services were not covered by insurance, he writes. MSN.

Widespread outrage over excessive health care costs and “surprise bills” spurred Congress to act. Before the end of March, senators from both parties plan to propose legislation that would help expand protection against surprise medical bills for insured patients. The effort may even gain support from President Donald Trump, who said during a recent roundtable on health care costs that he sees addressing “surprise bills” as a top priority.

Here is what can be done now.

1. Check and recheck your insurance network

If you know that you will be going to a hospital soon for a treatment, procedure or surgery, first make sure that this medical facility is part of your insurance network. More importantly, when you are admitted to a hospital or billed, check it all again and ask if all the services and procedures you intend to receive and go through will be covered by the insurance network.

According to the Consumer Union survey, Americans most often receive unexpected bills from anesthesiologists, radiologists, or pathologists who work at your hospital network, but are not included in the insurance company’s coverage network itself. The same applies to the laboratory and diagnostic departments. You may need an MRI before the operation, but the diagnostic department of the hospital may not be in your insurance network.

A preliminary review of your case at the hospital billing department or before working with doctors will help ensure that you are in charge of specialists who are either in your network or have agreed in advance to receive compensation for their services in the network.

2. Emergency care is expensive.

Emergency room visits are one of the main sources of “surprise bills.” In an emergency, you are usually treated at the nearest hospital, whether it is in your network or not. And you typically won't be able to ask whether every doctor you see is in your network.

In those emergency situations that are not severe emergencies and in which you or your loved one are in a conscious state (for example, a fracture or high temperature in a child), be sure to go to a hospital that belongs to your network and ask about this attending doctors. Studies show that up to 20,% of emergency doctors may not be part of the network in which the hospital is located.

If you find yourself with a pile of huge bills after visiting the emergency room, you can appeal these bills. Here's how to do it.

3. Official appeal

In many cases of surprise bills, patients file a formal appeal with their insurance company to get the costs covered. Sometimes insurers help with this process and negotiate lower medical fees. In other cases, you will have to go through several bureaucratic hoops to avoid paying huge sums out of your wallet.

To get help with an appeal, first contact your doctor, who can often help with documenting the claim and explain correctly why you unexpectedly received services outside the coverage network.

Also contact National Patient Protection Foundation, a non-profit organization that helps in the appeals process.

4. Learn the laws of your state

You can also find support from state insurance regulators. At last count, 21 states have laws that protect consumers from unexpected medical bills if they are covered by a state-regulated insurance policy. Protection methods vary from state to state, but in some cases you can actually change the amount of the bill.

To find out how this issue is resolved in your state, contact your local insurance commissioner.

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