posted March 31, 2014 12:48 PM
So what sort of recourse do consumers have when they receive big bills from out-of-network providers? The first step is to make sure your insurance plan paid what it should have, since many plans provide some coverage for out-of-network services. And if you were treated for an emergency service (in an emergency room or an extension of it), make sure the insurer paid at least what they would have paid to an in-network provider, said Cheryl Fish-Parcham, deputy director of health policy at Families USA, a Washington consumer advocacy group. Consumers should also check to see if their state has any additional protections against balance billing. Finally, consumers should talk to their providers about reducing any remaining charges.Consumers would do well to follow the lead of Ms. D’Andrea’s mother, Livia Cooper. The couple relied on her to deconstruct and analyze the reams of invoices that arrived in their mailbox — including a collection notice — since they were busy caring for Sienna.
Ms. Cooper spent countless hours poring over the bills, trying to make sense of it all. “It was so overwhelming,” said Ms. Cooper, who had to close the women’s boutique she ran with Ms. D’Andrea so they could focus on Sienna, who is now 9 months old. “We received department bills and there could be 60 invoices on one printout. You would have a bill for $8,100 from one department or $6,500 from another department. It was hard to figure out what was covered, what wasn’t covered and what was balance-billed.”
The billing service for the doctors initially wanted the D’Andreas to enroll in its budget plan, which Ms. Cooper refused to do before figuring what the couple actually owed. Her persistence ultimately paid off. She finally reached a supervisor in the billing department and explained that “we had insurance, were paying the co-insurance, co-payments and deductibles, and could not afford to pay any more than what we were obligated,” she said. She also pointed out that the providers were paid what they would have been paid if they were in the network.
As a result, many of their bills were reduced, and some were forgiven. The surgeon who repaired Sienna’s heart was in the plan’s network, for instance, but the assisting surgeon was not. And even though the insurer paid the assisting surgeon the same amount as the main surgeon, Ms. Cooper said that the couple was billed for $4,100, or the balance not covered by insurance. The billing department asked the couple to file an appeal with the insurer, which they did. As a result, the insurance company paid an additional $700 and the surgeon wrote off the balance.
NY TIMES
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posted March 31, 2014 12:30 PM
posted March 31, 2014 12:48 PM