You did everything right. You picked a doctor within your health plan network. You made sure the hospital was in your network. Yet you suddenly face a bill for thousands of dollars for doctors or anesthesiologists who were not in your network. Bait and switch, anyone?
Only about a quarter of the states have even the smallest protection for this. A few states — California, Connecticut, Florida and New York — have passed laws since 2015 giving stronger protections. If you live in another state — your politicians care more about donated campaign money from insurance companies than they care about you.
The Journal of the American Medical Assn (JAMA) investigated physician fees by specialty. While General Practitioners and other frequently seen doctors typically charge less than twice what Medicare pays, other specialties were substantially different. The worst were anesthesiologists — exactly a specialty likely to hit you with “out of network” surprise fees. They typically charge more than six times the Medicare rate.
Close behind them at four times the Medicare rate are other specialists who are also likely to surprise you by being out of your network: radiologists, emergency physicians, pathologists, and neurosurgeons.
Consumer Reports has worked with consumer advocacy organizations in several states to enact laws “barring out-of-network balance billing for services at in-network hospitals. Balance billing leaves the consumer on the hook for what the insurer doesn’t cover by an out-of-network doctor.”
There was an attempt to stop this practice this year. The End Surprise Billing Act, introduced by Rep. Lloyd Doggett (D-Texas) would have protected consumers from balance bills in emergency situations. Doggett plans to reintroduce the bill in 2019. Meanwhile a similar bill has been introduced by Sen. Bill Cassidy (R-La.).
Since both parties have introduced bills, hopefully the democrats and republicans will work together to pass one — instead of fighting to make sure only their party gets credit for introducing (but not getting passed) such a bill. Or is this too much to hope for?
What can you do?
Consumer Reports has some excellent advice, including talking to your doctor, talking to the hospital when you first fill out admission forms, and fighting the bill.
One great step you can take is to go to End Surprise Medical Bills at Consumers Union and join their campaign to apply political pressure on more states to protect their citizens. And to support legislation at the federal level.
Marlene Jensen is a 71-year-old full-time marketing professor. Previously she was a VP at CBS and ABC and spent decades as an entrepreneur and pricing author/consultant. Sadly, none of these prepared her for the onslaught of marketers who now think her daily interests/needs consist solely of hearing aids, wheel chairs, adult diapers, medi-alert buttons, medications, and bath tubs you walk into.