Medical Billing Surprises: Why Getting Checked Out in the ER Can Cause Unexpected Fees

medical billing, emergency room

In recent news, a woman got billed twice for a procedure. Here's how you can avoid this happening to you.

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Studies show that emergency room physicians are most likely to bill in excess of what your insurer would cover. Why? Hospitals contract with physicians groups for their ERs, but these same emergency doctors also make independent contracts with insurance and companies who might be totally different or unrelated insurers than the hospitals have coverage with.

The result is that you may require an ER visit and think that your insurance covers it because the hospital usually takes your insurance. But suddenly, you receive a bill for the full price of the ER visit! That's what happened to Lorena Martin, who brought her infant to the ER for a fractured foot. The hospital is listed as within her insurer's network, so she thought she was going to a care facility where her expenses would be covered. But one month later, she received a bill for $1,500, which she ended up paying about $1,000 out of pocket. She found out the hard way that the hospital's emergency department physicians aren't in her insurer's network.

Part of the problem is that medical billing company regulations, policies, and other miscellaneous laws and bylaws are updated often, and sometimes hospitals can't catch up. Hospital administrators might not realize that these changes may cause non-coverage in some of their departments.

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But the American College of Emergency Physicians released a statement defending ER doctors. They said it's not the emergency physicians' fault because insurance companies are narrowing their networks, which makes it increasingly more probable that physicians in the ER just won't be in the same network.

If you want to avoid medical billing surprises, do your research. If you have time to call the ER (if it's not a critical emergency) before heading over, ask them if their staff is covered under your insurer. Do the same if you have a non-emergency procedure planned – it's better to be safe than sorry.

If you end up receiving a surprise medical bill anyway, you can still appeal it with your insurance company and your state government's department of health.

Know that it's entirely possible to get a medical bill you weren't expecting due to technicalities. The issue is hot right now, with many patients experiencing the phenomenon. Protect yourself by doing your research before heading to a care facility.

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