Were you charged out of network fees for in network care? The NY Times weighs in.

Were you charged out of network fees for in network care? The NY Times weighs in.

As many of you who have ever had a medical procedure performed already know, once the visit is done ,the bills start coming. Unfortunately, in the United States, there is little transparency for what care costs, and often your in network facility may in fact use out of network providers for ancillary services such as anesthesia or other services. Even though you believed you were careful, and the insurance carrier paid their in network amount, the provider will sometimes balance bill you, leaving you with an expense you had not planned on.

While some states have banned this practice, most states have no controls over this and if you do not pay the bill, collections calls ensue as they try to collect amounts which can be above and beyond what your insurer will allow, even if the physician involved agreed to take the insurers reimbursement.

The NY Times investigated this phenomenon and offers some tips.

Out-of-Network Bills for In-Network Health Care

The robo-call from the physicians’ billing service had the intended effect: I panicked. It sounded like a collection agency. I almost paid what it asked.In fact, we didn’t owe a dime. By the time we got the call last week, followed by bills in the mail, our insurer, United Healthcare, had already paid most of the charges stemming from my daughter’s emergency room visit in late August, when she had a nasty fall shortly after returning to college. Cayuga Medical Center in Ithaca isn’t in our insurer’s network, but United handled the bills as though it was because it had been an emergency, paying the hospital nearly $900. We paid only the $100 emergency room co-pay.

The doctors were another story. Cayuga Emergency Physicians billed $563. Again, United treated the service as in-network, and the physicians agreed to accept the plan’s payment of $237.81.

But then the doctors turned around and charged us for the difference.

When there’s a difference between the charge and the insurance reimbursement, and a health care provider tries to collect the difference from the patient — that is balance billing. Critics call it a huge problem, even for people with relatively good insurance. The California Association of Health Plans reported in 2007 that 1.76 million state residents who visited emergency rooms over a two-year period were balance-billed $300 each on average. Sometimes the charges were legitimate and sometimes not, but about half paid the bills anyway.

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