Calling 911 on Surprise Medical Bills

Conor Laing
Assistant Policy Analyst

Friday, May 13th, 2016
Texas

I remember the night I was dehydrated and had severe abdominal pain.  It was an incredibly terrifying experience, and my family rushed me to the ER with all of us believing something was horribly wrong.  We did not think about the cost or our insurance provider network.  Getting me to a doctor was the most important thing that night. This is the way emergency care should work; in an emergency the focus needs to be on getting care.

But all too often, emergency medical care leads to an expensive surprise out-of-network medical bill. According to our survey, 30 percent of privately insured Americans have received a surprise medical bill in the past two years. Two-thirds of emergency room doctors are independent contractors, which means that it is very possible that an emergency room doctor (or doctors) is outside of any given patient’s insurance network and can send the patient a surprise bill.  Specialists like anesthesiologists or radiologists may be called in during a procedure and are often out-of-network.  Labs that run tests may also be outside of a patient’s insurance network. An ambulance may also be outside of the patient’s insurance network. And so on.

There are some strategies consumers can use to protect themselves in these situations. Knowing what services your insurance plan covers, which emergency rooms and ER doctors are in-network, and how ambulances are covered can be helpful. If you get a surprise bill, you should wait for your insurer to send an explanation of benefits (EOB) before paying. But ultimately, in a medical emergency the dispatcher will send the closest ambulance and the ambulance crew has the final say in which emergency room a patient is taken to.  In a medical emergency, there is very little you have control over. And let’s face facts, very few of us are thinking about our health insurance networks when there is blood everywhere.

The good news is that many states have or are in the process of working toward protecting consumers from surprise out-of-network medical bills including New York, Connecticut, and Florida.  We have teamed up with state advocates and Consumers Union story sharers to end surprise medical bills in California, New Jersey, and other states.   In order to stand up to medical industry lobbyists and win protections, we will need your voice in the fight.

Have you received a surprise out-of-network medical bill and need assistance? Use our Insurance Complaint Tool. Help us change this unfair system. Sign our petition to join our growing campaign. Together we can end surprise medical bills!

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