Surprise medical bills occur when a patient is billed more than expected for a treatment or procedure because, while the facility or primary doctor that they saw was within their insurance network, another healthcare provider (such as an anesthesiologist for an operation) was not. In these cases, hospitals can use “balance billing” to charge the patient the full balance of what the hospital chooses to charge minus what insurance was willing to pay. When significant portions of the bill are deemed to be out-of-network by the insurer, these costs can be significant. Our affiliates at WBRC in Birmingham, Alabama interviewed Call For Action’s president, Shirley Rooker and report on the issue.
- The American Hospital Association published a guide to help patients avoid surprise medical bills.
- Shirley Rooker explains that even if you’ve done all your homework ahead of a hospital trip, you can still end up with surprise charges. “You may be unconscious and an anesthesiologist may be there working with you. Someone else may come in and be a participant and that person may not be a part of your program…and there you are stuck with a bill and your insurance provider is probably going to say nope..we’re not going to pay for it.”
- Protections against surprise medical bills vary by state. A study by the Commonwealth Fund outlines the consumer protections available in each state.
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