Out-of-Network Horror Stories

In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees. They may be called in when the need for them is questionable. And patients usually do not realize they have been involved or are charging until the bill arrives.

The practice increases revenue for physicians and other health care workers at a time when insurers are cutting down reimbursement for many services.

I want to share this article about surprise medical bills with you but it fills me with so much anxiety I don’t even know where to begin.

Basically it is about people who get surgery and when they are in no place to decline medical services, assistant surgeons and the like show up on the scene, do some work, and surprise — they don’t accept your insurance! Or you insurance doesn’t cover their services! Hello, bills over $100k. My heart is racing as I type this.

The phenomenon can take many forms. In some instances, a patient may be lying on a gurney in the emergency room or in a hospital bed, unaware that all of the people in white coats or scrubs who turn up at the bedside will charge for their services. At times, a fully trained physician is called in when a resident or a nurse, who would not charge, would have sufficed. Services that were once included in the daily hospital rate are now often provided by contractors, and even many emergency rooms are staffed by out-of-network physicians who bill separately.

…When insurers intervene in a particular case, they say they have limited ability to fight back. Insurance examiners “are not in the room on the day of surgery to see the second surgeon walk into the room or why they were needed,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, an industry group. And current laws do not require hospitals that join an insurance network to provide in-network doctors, labs or X-rays, for example.

I am dealing with this on a minor scale with my c-section. My insurance-taking pediatrician didn’t have privileges at the hospital where I gave birth and it seems the pediatrician they sent my way doesn’t take my insurance. They haven’t come out and said that yet but I am getting the billing run-around and realizing I should have stopped everyone that dealt with me in the hospital to ask them if they took my insurance, and asked them to leave if they didn’t.

One billing department rep last week asked me what insurance my child had when he was born. I was like, “Um he was a fetus until 9pm that day so he didn’t exactly have health insurance. Isn’t he covered under my plan?” “Well did you add him to your plan?” “No.” He has CHIP. “Then no.” “UMMM.” “We’ll send you your final bill Friday.” I hung up and cried. Then called my insurance and they said the baby is covered under me for the first 30 days of his life. AS IT SHOULD BE.

I also called the billing department for my OB’s office. I was uninsured the first few months of pregnancy and I am still trying to negotiate a discounted self-pay rate. The woman was like, “Yes, I see you have called three times and I have filed 3x for the discount but no one has gotten back to me. Can you call the office and ask to speak to the manager and tell them to get back to me?”

Of course, all of these bills are merely in the thousands, not the ten thousands or hundred thousands. I guess I should consider myself lucky?

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