3 ms·
One of the problems here is that the patient can believe they're at an in-network provider — and be correct about that — and still get hit with "out of network"
by deathanatos 2y ago
One of the problems here is that the patient can believe they're at an in-network provider — and be correct about that — and still get hit with "out of network" charges.
One of the linked articles[1] explains it slightly better:
> Surprise medical bills happen when a doctor or other provider who isn’t in a patient’s insurance network is unexpectedly involved in a patient’s care. Patients may go to a hospital that accepts their insurance, for example, but get treatment from emergency room physicians or anesthesiologists who don’t — and who then send patients big bills directly.
I've seen this in my own medical billing: often times, I will get bills (to the insurance) from "providers" I had no (direct) interaction with. And that's the thing: if a in-network provider contracts/vendors/(who knows, I don't know how their business is structured) to some other company, you get billed "randomly". Sometimes I can piece together exactly what action caused it (e.g., okay, that ultrasound is this random charge), but not all the time.
Insurers refuse to help: they claim it's not their problem, as they're not billing you. Providers will claim they know nothing; after all, it isn't them that billed you.
[1]: https://www.nytimes.com/2021/07/01/upshot/surprise-medical-bills-biden.html https://www.nytimes.com/2021/07/01/upshot/surprise-medical-b...
- ipython 2y agoThis +1000. The whole billing / insurance system is intended to wear you down in a cascading swarm of bullshit. You want to know if a doctor is in network? Good luck, because the insurance company clearly states that they only provide that information on a best effort basis. The doctor can’t answer, as they refer you back to your insurance company. You want an outpatient surgery? Great! Make sure your doctor and facility is in network, right? Oops, wrong again! You forgot about the anesthesiologist who you can’t pick ahead of time and is rarely in network. Good luck figuring that out later! It’s intended to wear you down until you’re afraid of your “rating” aka credit score tanking enough that you just pay up.
- maxerickson 2y agoThere was legislation that changed this a couple years ago. https://www.cms.gov/nosurprises/ending-surprise-medical-bills https://www.cms.gov/nosurprises/ending-surprise-medical-bill...
- ipython 2y agoAll well and good until you sign away those rights in one of the many forms you fill out- see for example this excerpt from one of my local hospital websites (emphasis mine) It’s trivial to be coerced into signing one of these agreements when you’re in a high stress high stakes environment. > If you get other types of services at these in-network facilities, out-of-network providers can't balance bill you, _unless you give written consent and give up your protections._
- pushedx 2y agoLast year I had minor surgery, and before the procedure started, I asked the anaesthesiologist if she was out of network. Her response: laughter. Very comforting when I was about to trust her with my life. Turns out she was out of network, and the cost of the anesthesia on top of my in-network hospital bill was around $1050.
- metalcrow 2y agoCan you simply just not pay? What are the legal consequences in that case? Effectively some random 3rd party is requesting you pay them for something you didn't ask for or contract them to do.
- jrs235 2y agoThey'll likely send it to collections (and hurt your credit score).
- asvitkine 2y agoWhy are randos allowed to bill you directly if you didn't sign a contract with them? Shouldn't anyone working at the hospital be under contract with that hospital? Why did the hospital share your personal information with those people without your explicit consent?