Surprise Medical Bills

When you or a loved one is injured in a catastrophic accident, receiving emergency medical services as quickly as possible is the first priority. The last thought on your mind during an emergency is the cost of the medical procedures or whether insurance will cover the lifesaving treatment needed.

Sadly, some areas of the medical field seem to prey on consumers when it comes to charging extraordinary costs for their services, sticking patients with a huge bill the moment they enter recovery:

• A Connecticut mother took her 15-year-old daughter to get blood drawn for a tendon injury in her ankle. When the doctor had difficulty, she sent them to an outpatient surgical center owned by Hartford Hospital and walked away with a facility fee of $1,200- four times more than she thought it would cost!
• The father of a teenage boy in Framingham, Massachusetts was experiencing chest pains that his doctor feared might be a punctured lung. He agreed to let the doctor call for a ground ambulance to take him to a hospital only 2-miles away and ended up with a bill for $2,400 since the company was Out-of-Network.
• When a young girl from Texas was badly burned in her backyard, paramedics insisted the use of an air ambulance was necessary to transport her to the nearest burn center. Two months after her full recovery, the family received a bill from the air ambulance company for over $18,000! They are still fighting the bill after four years, reporting major damage to their credit as a result.

Surprise medical bills are traumatic and financially cruel, especially for individuals already paying high insurance premiums. Several states including Connecticut have enacted laws to help prevent the occurrence of high costing surprise medical bills, but even these regulations have their limits.

CT’s Surprise Bill Law

In 2015, the ‘Surprise Bill Law’ PA #15-146 took effect in Connecticut after consumer complaints regarding surprise medical bills hit alarming rates. Connecticut became one of only six states establishing comprehensive laws protecting consumers in the country, aiming to reduce the number of surprise medical costs received by unsuspecting patients. Here’s what you need to know about the law:

• Emergency Services: Patients who see Out-of-Network providers for emergency services can only be required to pay the equivalent of In-Network costs. This includes Out-of-Network hospitals, transportation services, and providers who are Out-of-Network practicing within In-Network facilities.
• Unfair Trade: Patients do not have to pay surprise bills from healthcare providers that show an excess of their legal obligation without the wording “This is not a bill” printed on the statement to trick them into overpayment of services.
• Fees: All healthcare bills must have complete transparency of costs charged to the patient including facility fees, restrictions, price of medical care, etc.
• Referrals: Physicians/providers can refer patients to specialists they are affiliated with but must (in writing) state that the patient can see other providers In-Network if they choose.
• Statewide Health Information Sharing: The bill calls for a statewide health sharing program to allow all providers access to patient information if needed.
• Provider Updates: Insurance companies cannot update their In-Network provider directory more than once a month and the physicians must notify insurance companies within 30-days of pulling out.

When it comes to the Connecticut state health laws, the intention to protect patients may seem comforting at first. However, if a surprise bill lands on your doorstep, they may do little to defend you. Not all insurance plans or services are covered under state health laws and residents should be aware of the loopholes to avoid obscene costs in the future.

Insurances Neglected By CT

Millions of Americans are in a category of health insurance referred to as self-funded insurance, approximately 61 percent of covered employees across the United States. Most state health laws do not apply to these types of plans, particularly larger companies who may operate their headquarters out of other states. Patients who are expecting to be protected by Connecticut health laws might be in for a shock when their bill arrives without doing their research into their plan.

Outrageously Priced Ambulance Rides

Ground ambulatory services are becoming more competitive as the need arises, yet less likely to join insurance plans due to conflict with price agreements. Ambulances can be either private or publicly owned. If you require an ambulance and are unable to choose your service because of your medical condition, you will most likely be protected. But if you’re unaware a service is not In-Network and you willingly accept an ambulance ride under panic, you could be looking at an outrageous cost for a short ride.

Air Ambulances can be lifesaving for serious injuries, but incur outrageous costs for services. U.S. government health programs, including Medicare and Medicaid, do not cover the expenses of these flights, and insurance companies cover little if any of the costs. A larger issue is more and more patients are being flown by these ambulatory services that really don’t need them, costing consumers high costs for and years of disputing bills for unnecessary rides.

Confusing Facility Fees

Connecticut law requires that facility fees be listed on all medical bills for patients knowledge. That’s great…but most patients don’t even know what these fees are! Facility fees are charged by hospitals for outpatient services at other facilities they own to cover the operational costs. It doesn’t matter if you visit the facility for an hour, five hours, or even five minutes, your medical bill will be subject to a fee just for being there.

Patients may now be more aware that facility fees exist with the additional wording on their bill but it doesn’t mean they understand them or would know if they’re paying too much. Facility fees can come as a complete shock to patients, particularly when an outpatient center is recommended by another provider. In two years, reports show Connecticut hospitals have billed over $1-million in facility fees to patients- some of them having to pay completely out of pocket.

Illegal Balance Billing

The act of balance billing has been illegal for sometime in Connecticut but it doesn’t stop greedy providers from doing it anyway. Balance billing is a process by which the provider bills the patient directly for the difference between the provider’s charge and the allowed amount by the insurance company. It’s illegal in Connecticut for any provider to request payment from a patient who is covered by insurance as the entire purpose of insurance is to negotiate prices for you. Medical practices will wrongfully bill patients for services that may be covered under insurance hoping to receive payment from individuals who aren’t aware of the law.

Out-of-Network Schemes

Some of the surprise Out-of-Network costs have been resolved with the ‘Surprise Bill Law’, but many situations still remain open for patients to get nailed with unnecessary costs.  Patients who agree to receive treatment from Out-of-Network providers when In-Network providers are available are susceptible to the cost difference…not all situations are this simple. If your dependent is in an emergency situation or you are provided limited information by a doctor during a stressful event, you may not consider the costs of going with Out-of-Network care if you believe (or were led to believe) the treatment is necessary.

How To Prevent Sky-high Medical Bills

It’s natural to think unclearly during a medical emergency and go with the recommendations that sound appropriate at the time. But if you are able to plan a bit ahead of your medical procedure, WebMD offers some preventative steps you can take to reduce your chances of being smacked with a costly surprise bill:

1. Know your medical plan: Read your benefits and know what emergency costs are covered. Always carry your card with you in case you need to reference it or call the company in pinch.
2. Carry the business card of your providers: Have the names of your typical providers with you in the case you need to call them with questions and concerns about services.
3. Call before your procedure: Before your procedure is set to take place, call your health plan to make sure nothing has changed as far as coverage and In-Network providers.
4. Ask about cost: Your insurer will typically offer a price tool online to help you estimate the costs for a procedure to prevent sticker shock from uncovered costs.
5. Look into state health laws: Check to see which Connecticut health laws you may be protected under before your procedure or to be prepared in the case of an emergency situation.