Wednesday, April 5, 2017
Surprise Medical Billing
The problem is that insurance companies negotiate with hospitals, doctors and anesthesiologists for a lower rate. The health providers who refuse to negotiate are marked "out-of-network" and this is where the problem arises. You can go to a hospital that is in-network, but the doctor may be out-of-network and they don't accept a lower rate and therefore the costs are passed on to the patient, which some have reported to be $20,000 or more. The same goes for the anesthesiologist. Unfortunately, even for scheduled surgery, you won't know who is providing this surgery and whether they are in or out of network - hence the surprise billing. It's often called balanced billing when the doctors and insurers can't agree on prices for medical costs. The patient is the one who suffers. Florida, California, New York and Illinois each has policies to help the patient with these surprise bills, but Texas is the worst state for surprise bills with many in-network hospitals having a staff of doctors who are all out-of-network.
The 2015 Texas Senate Bill 481 offers some relief for patients receiving bills from unknowingly using out-of-network providers. Patients can mediate bills of over $500 but very few are successful in navigating the complicating system.
If all else fails, try and negotiate directly with the doctor's office. Often they will take a lower amount if you can pay cash. Make sure you write "payment in full" both on the memo section of the check and at the top of the back so that when it's endorsed it's showing they agreed to payment in full.