It’s hard to admit, but I am old enough to remember a time when a trip to the doctor meant a payment in full before leaving the physician’s office. Back then, many of us only had health insurance for hospital stays and didn’t expect to use it unless we had some sort of catastrophe. Well times sure have changed. Now we use our insurance plans for every possible healthcare encounter. We do our best to insure that our physicians are in our “network” and hope our medications are available in the less expensive generic form. We try to keep up with the changes in healthcare and coverage. But life moves quickly and our lives are busy managing work, home, family and more. So sometimes, we get hit with an unwelcome surprise. I am speaking about that surprise bill from a doctor, radiologist, anesthesiologist or other healthcare professional who you thought should have been paid by your major medical plan. After all, you called the radiology center to make sure they took your insurance. You clearly know that your hospital is in network. And aren’t ER visits automatically covered?
What you might not known is that the physicians who work at these facilities do not have to accept your plan and that you may have to settle their bill directly with them. I’ve heard stories from folks who have received bills for hundreds or thousands of dollars and have even experienced this myself. The problem is so widespread, that the State of New York recently completed an in-depth report on the problem. They found that some out-of-network providers, particularly those in emergency services, were charging several times more than a private or public payor system allows. The issue is complex and solutions need to be managed by consumers, insurers, hospitals and other providers. And, while healthcare reform hopes to reduce the number of Americans without health insurance, the gap may still exist for unexpected medical bills.