A recent article in US News and World Reportexplained a little known fact of which most patients are completely unaware. A trip to the emergency room could cause a secondary injury to a patient’s wallet. Even if a patient goes to a hospital included in his or her health insurance network, if the emergency room physician who treats the patient is not part of the health insurance network, the patient will be responsible for a separate and unexpected bill.
Is this a big problem?
Research conducted by Yale University found that roughly 2 of 10 in-network visits involved a doctor not in the patient’s insurance network. Going to an in-network hospital does not mean all your charges will be covered.
There is some slight hope in these situations. If you are attended by an out-of-network doctor, it doesn’t necessarily mean financial calamity. That can depend, in part, on the patient’s insurance coverage. And, some states like New York have laws that offer some protection against surprise bills, although the extent of that protection varies.
There are limited options to rectify the unexpected charges. Patients can ask that the claim be processed again as in-network care since the patient had no way of knowing the doctor was out of network or they can try to negotiate a lower bill.
In recent years, especially since the creation of the Affordable Care Act’s public insurance exchanges, insurers have formed networks of doctors and hospitals, in part, to gain some leverage for negotiating reimbursements.
When the medical treatment is an emergency situation, you don’t always have time to question the physician’s insurance network coverage. However, if you have time, it’s a good thing to make sure your attending physician is part of your health network.