Hospital-Bill Sucker Punch

Date: November 15, 2014      Publication: Bottom Line Personal      Source: Elisabeth Ryden Benjamin      Print:

The latest health-care trap: What starts out as an in-network hospital visit fully covered by insurance turns into a surprise out-of-network bill for hundreds or even tens of thousands of dollars. That’s what many patients are discovering after they undergo treatment and/or surgery, especially in emergencies. The reason: Doctors and hospitals belonging to your insurer’s network may use out-of-network specialists, consultants, assistants and other hospital employees without you knowing it. The insurer then covers only a small portion—or none—of the out-of-network provider’s fee, and you are billed for the rest. Example: One ER patient got a bill for $937. Insurance paid $151.02. The patient owed $785.98.

Patients typically don’t realize they are authorizing this when they sign hospital consent forms. Unlike in-network providers who agree to discounted rates negotiated with the insurer, out-of-­network providers charge their full fees, which may be 20 to 40 times higher.

There is some legal protection. Medicare doesn’t allow providers who accept Medicare payments to bill patients beyond what Medicare covers. And 13 states have a variety of ­restrictions on whether and how much patients can be charged for medical services such as anesthesia that often are ­provided by out-of-network providers.


To protect yourself…

• Know which hospitals are in your network in case of an emergency. Then ask what percentage of ER doctors and other personnel there are out of network. If most are out of network, consider choosing a different hospital.

• If you’re having a planned procedure, ask your doctor well in advance who else might be involved in your case, and insist that everyone be in-network unless there is an overriding need for someone out of network to take part. Seek to work out terms in advance with out-of-network providers.

If you do face out-of-network fees…

• Your insurer may be willing to cover more of the cost and/or convince the provider to lower the bill. You also can file an appeal with the insurer.


• Ask your state attorney general to intercede.

Source: Health consumer advocate Elisabeth Ryden Benjamin, vice president of health initiatives at Community Service Society, a nonprofit advocacy group, New York City.

  • paulie2

    $785.00??? What’s that – nothing. I took my daughter to an in-network hospital after she passed out and hit her head. By the time we got done, we got a bill for…ready for this?…$12,687.20. The ER doc was out of network, the CAT scan reader, the radiology dept, and the lab…all out of network. I really don’t understand how that could be. I tried to fight it—nothing worked. Then, finally they “made a deal” with me and I owed 1/2 ($6,300) and am still paying that off a year later. The whole thing is crazy.

  • gratefulmouse

    every now and then I take a 3mg..when I was having trouble with sleeping….I had it often and to the point it was driving me crazy…then I got off my two allergy meds and discovered I could sleep….I was tired all the time yet couldn’t sleep unless it was in the day time…I couldn’t sleep at nite actually and could sleep during the day and sometimes 12hrs in the day time….upon getting off the allergy meds I discovered I had more energy during the daytime to move about more and think more clearly…enough to help me sleep at night or grow tired at nite..I have barretts esophagus…. was put on two different acid reducers. zantac 150 and Prilosec ..both perscrition not over the counter…I have been on it now for almost 3yrs…I was still burning and it seemed like it wasn’t working…well, I had another sleep study as I was snoring so bad …and I had one which said I didn’t have apnea but had nocturnal panic attacks…which there is no such thing as….what the dr saw was me shaking a lot from not being able to breathe…then I had the second sleep study and by a neurologist who saw that I had severe sleep apnea..not breathing every 1 or two minutes…I knew that because I felt my palette drop in the back of my throat one time..with that info…I was given a cpap machine…then at the same time…I saw a allergy dr and he put me on three things…all day allergy and montelukas and a nasal spray…with all that plus my seizure meds keppra ..I felt like a zombie…anyway ..the new allergy pills caused my barretts to feel better….along with using the cpap machine…I realized that my sleep apnea was causing my barretts esophagus…my body was jerking and my muslces tensing and causing the acids to build up in my stomach and because I wasn’t breathing right and fighting to breathe that acid would come up to the esophagus and stay right there…and burned and ate up that part that goes into the stomach…so skin like my stomach or intestine was growing there…however weird it was the all day allergy pill helped to clear it up along with the cpap machine…amazing….I am off the allergy meds as I stated earlier because I was like a zombie on anyone of them. now that I use my cpap my body isn’t jerking around and the acid has dropped in my stomach healing the barretts as my last test or endoscopy showed it was good…so they don’t want to see me for 2yrs meaning to me …its not dangerous any longer or its not there….I should be able to get off the acid reducers or at least get off one of them….but they say I need to stay on for the rest of my life…which I doubt because I discovered that sleep apnea can cause barretts esophagus….also maybe some weight loss would help with the apnea…there are ways….I tried to tell the drs my info but they don’t want to hear it….Im not a scientist…however Im the body this is happening to and I am a watchful person noticing things that work and things that don’t….in todays world…a dr doesn’t want to see you unless you are on the drugs he prescribes…and boy do they prescribe them….