Have you ever gone to the emergency room within a hospital including in your insurance network, only to find yourself blindsided with a high medical bill based on out-of-network pricing? If so, you are not alone. A recent study published in The New England Journal of Medicine concluded that around 22% of hospital visits will involve surprise bills that the patients need to pay out of their own pockets.
The source of the problem is unclear insurance coverage and billing. Patients go to a hospital or facility that they know is in their network but then receive treatment from a doctor who is not. Since this typically arises in an emergency, the patient does not have the wherewithal or ability to ask if the doctor’s services will also be covered by their insurance. That doctor then bills the insurance company separately from the hospital, and if no agreement for payment can be made between the insurer and the doctor, the bill falls onto the patient’s lap.
Putting an End to Surprise Billing
Senator Bill Nelson of Florida has asked that the Federal Trade Commission (FTC) look into surprise billing, as it appears to be nothing more than an elaborate bait-and-switch practice. Within his letter to the FTC, he pointed out that in many cases, patients have little to no choice of who treats them. Imagine showing up to a restaurant, having the most expensive plate shoved in front of you, and then being forced to pay in full; it would be completely unacceptable and an egregious violation of consumer rights.
At this time, there is no clear indication if the FTC will investigate surprise billing practices at medical centers and hospitals. Even if it does decide to conduct its own research, the solution will need to come from legislative changes passed by Congress, not necessarily the actions of the Commission itself. Additionally, if the problem occurs at a non-profit hospital – such as a large percentage of all hospitals – the FTC will not have authority over it.
In the meantime, patients and consumers need to protect and stand up for themselves. Contact us today for a free case evaluation, during which we can review your claim and let you know what you should do next.