An American was admitted to the hospital with a broken jaw and received a $ 7 "surprise" bill

28-January 34-year-old Scott Kohan was attacked and his jaw was broken in two places. Witnesses to the incident called 911, and Kohan unconscious was taken to the emergency room in downtown Osti, Texas, writes Vox.

Фото: Depositphotos

At the hospital, Kohan came to his senses, and the nurse explained to him that he needed surgery. The man tried to check whether the hospital Dell Seton Medical Center in the list of hospitals covered by his health insurance.

"I lay there with a broken celestia, through iPhone went to the site Human and found the hospital on the right list,” says the man.

But it turned out that the emergency department is on the list of insurance, but the maxillofacial surgeon who was on duty at the hospital is not. Therefore, for the treatment of Kohan came the bill in $ 7 924.

“Looking back, I don’t know what I could have done differently. I couldn't go home. My jaw was broken in two places. I tried to check to see if the hospital was in the insurance network,” Kohan says.

According to Vox, medical bills- “surprises” are common in emergency departments. Kohan's experience is not unique. The publication has collected over the 6 months more than 1300 emergency bills, which were received by readers of the publication in all 50 states and in Washington DC.

Over the past decades, payment in emergency rooms has increased dramatically. And when health insurance plans do not pay, patients are left with burdensome bills. Analysis of the publication showed that patients are especially vulnerable when network doctors work in hospitals.

Christopher Harmon, a professor at the University of Missouri Kansas City, published a study that found that one out of five emergency room visitors received a service from a provider outside the insurance network.

“When someone goes out of network and the patient knows about it, then they can avoid those providers. It's very difficult for patients here to understand that this is going to happen,” says Garmon.

According to him, more often than not, “surprises” are received by people who, while in the emergency room, were hospitalized for further treatment. 20% of these patients receive scores of “surprises”, mainly from such doctors as anesthesiologists and pathologists.

Patients who come to such departments with a shorter visit also remain at risk. 14% of these patients receive a score of “surprises” for the care provided during their visit.

When doctors and hospitals join a health plan's network, they agree to specific rates for their services, ranging from routine to complex surgery. Doctors typically work out-of-network when they can't negotiate a good deal—when they think the insurance plan is offering rates that are too low.

If the state does not operate a law regulating the provision of services outside the network, then most patients are held hostage to such situations.

Especially prevalent are the “surprises” in the state of Texas, where Cohan lives. Harmon's research shows that 34% of emergency room visits result in such bills — this is above the average of 20% across the country.

According to Center for Public Policy Prioritiesin Texas at 18% of hospitals Blue cross Doctors outside the insurance networks work, and 63% in hospitals Human.

Kohan only a week after the operation realized that something was wrong with his medical bill.

“A week later I checked the site very carefully Human. I saw that all the services I received showed up, except for the surgery,” he says.

Kohan decided that nothing happened, that the doctor most likely coded the visit incorrectly and just needed to reapply. The doctor Kohana repeated the application and increased the transaction price by about $ 2300 dollars.

Humana once again denied the claim. Kohan could not get a rebuttal account.

In Texas, there is a law from 2009, which allows customers to deal with such matters as that of Kohan. Patients can contact the authorities if they receive a “surprise” bill over $ 500 and then the state insurance department begins the process of resolving the dispute between the hospital and the service provider. But not all residents of the state are aware of this possibility.

Research Pogue show that only 3 824 patients have taken advantage of this law since 2009. CPPP says that since 2009, around 250, 000 residents of the state have received “surprise” invoices.

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