You just got a surprise emergency room bill…now what?

Spencer Watson
Public Policy Intern

Wednesday, August 10th, 2016

“If you’re having a heart attack,” says Karen Pollitz, senior fellow at the Kaiser Family Foundation, you’re probably “not going to ask if the doctor treating you takes your insurance” as you are getting wheeled into the hospital.

Patients across America check into hospitals with a medical emergency and come out with a billing emergency due to  surprise out-of-network charges for anesthesiologists, ambulances, and labs, none of which they should have known to ask about. This could happen to anyone, which is why Consumer Reports shares the best ways patients can plan ahead to avoid surprise ER charges. You should:

  • Know what emergency care hospitals and services your insurance plan will or will not cover by requesting provider directories and documentation, but be aware what they send you may not be up to date.
  • If possible, request in-network doctors when you, or anyone helping you, complete the hospital intake forms.
  • Request and keep all your paperwork from your visit, including the itemized printout of charges.

It doesn’t take a brain surgeon to know that in medical emergencies, patients don’t have the ability to be in control of every service they receive. Often, patients don’t even know which doctors are seeing them, let alone whether they are in-network or not.  If surprise bills start to come in, knowing your options can help you fight back and get the bill covered, reduced, or settled. Consumer Reports recommends you:

  1. Pay nothing until you get your explanation of benefits (EOB) from your insurer; compare bills to ensure you received the service and check with your insurer to confirm it is not covered.
  2. Ask questions before you pay. First, ask your insurer whether it’s willing to cover the services provided. You can also ask the provider who billed you whether they are willing to settle for what insurance has already paid.
  3. If that strategy doesn’t work, file an appeal with your insurance company, and ask your primary care doctor for a letter telling them your ER treatment was “medically necessary” to include with the appeal. If you need help doing so, groups like the Patient Advocate Foundation may offer guidance.
  4. Lastly, professional claims consultants (e.g. National Association of Healthcare Advocacy Consultants, Alliance of Claims Assistance Professionals) may be able to help you settle the bill, for a fee.

The bottom line is: in a medical emergency, you shouldn’t have to deal with the second pain of dealing with a financial emergency due to surprise billing loopholes. Which is why  thousands of Consumers Union activists are standing up and speaking out about unfair out-of-network charges, inspiring 23 states to move toward or pass legislation protecting patients from surprise medical bills.

If you have ever gotten a surprise medical bill, please join our consumer movement to #EndSurpriseMedicalBills by sharing your story today, or use our insurance complaint tool to find local state resources on fighting your medical bills.

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