5 ms·

What you're describing is completely illegal now. Under the Affordable Care Act, which applies nationwide, insurers are required to cover out-of-network emergen

What you're describing is completely illegal now. Under the Affordable Care Act, which applies nationwide, insurers are required to cover out-of-network emergency care as if it was in-network care, which means your deductible and coinsurance can't be higher than the regular in-network amounts.

lotsofpulp 6y ago
As far as I understand, the out of network provider can still come after you for whatever the insurance doesn’t pay them. In the US, you basically provide your healthcare provider with a blank check.
Someone1234 6y ago
Everything I said happened under the ACA. It was "only" $10K because of the ACA's out-of-pocket maximums. A quick google suggests this is common: > It's important to understand, however, that the out-of-network emergency room does not have a contract with your insurer, and is not obligated to accept their payment as payment in full. If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts you pay.
- learc83 6y ago
  You said >Since then kid themselves also had an ambulance ride (seizure), and that too was "out of networking" in spite of being the only ambulance provider available within 15+ minutes. That's the illegal part.
  - Someone1234 6y ago
    If you say so. The $1,500+ ambulance bill still existed, I still paid it, and my kid wasn't even born until five+ years after the ACA came into force. The insurance company was "nice" enough to let me count it towards my kid's deductible for that year, but I paid every cent.
    - learc83 6y ago
      People will gladly collect money they aren't legally owed. In this case, unless there is more to the story, you shouldn't have paid it.
      - HarryHirsch 6y ago
        In normal countries you don't have that kind of criminogenic environment. Also, do stop the victim blaming.
        learc83 6y ago
        >In normal countries you don't have that kind of criminogenic environment. Also, do stop the victim blaming. Stop using "victim blaming" as a way to shut down discourse. In every country in the world people run scams. Universal healthcare would make these particular kinds of scams a lot harder, but I guarantee you, you could still find this kind of anecdotal evidence of criminal behavior relating to healthcare.
  - surfmike 6y ago
    I’ve had that experience too. What makes you think it’s illegal?
    - learc83 6y ago
      For emergency treatments, insurance companies are required by the ACA to pay the out of network provider, but charge you as if you are using an in network provider. It's possible for the out of network provider to then bill separately from your insurance if they charge more than what your insurance pays out of network providers, but there's no way that's what happened here because $1500 after the out of network fee from the insurance company is far too high for an ambulance trip.
      - surfmike 6y ago
        I see. Any parts of the law I can cite if I complain? At least in my case and OPs it doesn’t seem that the law is being followed in practice.
- FireBeyond 6y ago
  Balance billing is (far too slowly) moving towards being illegal: https://www.commonwealthfund.org/blog/2019/state-efforts-protect-consumers-balance-billing https://www.commonwealthfund.org/blog/2019/state-efforts-pro...

lotsofpulp 6y ago

As far as I understand, the out of network provider can still come after you for whatever the insurance doesn’t pay them. In the US, you basically provide your healthcare provider with a blank check.

Someone1234 6y ago

Everything I said happened under the ACA. It was "only" $10K because of the ACA's out-of-pocket maximums. A quick google suggests this is common: > It's important to understand, however, that the out-of-network emergency room does not have a contract with your insurer, and is not obligated to accept their payment as payment in full. If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts you pay.

learc83 6y ago
You said >Since then kid themselves also had an ambulance ride (seizure), and that too was "out of networking" in spite of being the only ambulance provider available within 15+ minutes. That's the illegal part.
- Someone1234 6y ago
  If you say so. The $1,500+ ambulance bill still existed, I still paid it, and my kid wasn't even born until five+ years after the ACA came into force. The insurance company was "nice" enough to let me count it towards my kid's deductible for that year, but I paid every cent.
  - learc83 6y ago
    People will gladly collect money they aren't legally owed. In this case, unless there is more to the story, you shouldn't have paid it.
    - HarryHirsch 6y ago
      In normal countries you don't have that kind of criminogenic environment. Also, do stop the victim blaming.
      - learc83 6y ago
        >In normal countries you don't have that kind of criminogenic environment. Also, do stop the victim blaming. Stop using "victim blaming" as a way to shut down discourse. In every country in the world people run scams. Universal healthcare would make these particular kinds of scams a lot harder, but I guarantee you, you could still find this kind of anecdotal evidence of criminal behavior relating to healthcare.
- surfmike 6y ago
  I’ve had that experience too. What makes you think it’s illegal?
  - learc83 6y ago
    For emergency treatments, insurance companies are required by the ACA to pay the out of network provider, but charge you as if you are using an in network provider. It's possible for the out of network provider to then bill separately from your insurance if they charge more than what your insurance pays out of network providers, but there's no way that's what happened here because $1500 after the out of network fee from the insurance company is far too high for an ambulance trip.
    - surfmike 6y ago
      I see. Any parts of the law I can cite if I complain? At least in my case and OPs it doesn’t seem that the law is being followed in practice.
FireBeyond 6y ago
Balance billing is (far too slowly) moving towards being illegal: https://www.commonwealthfund.org/blog/2019/state-efforts-protect-consumers-balance-billing https://www.commonwealthfund.org/blog/2019/state-efforts-pro...