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Emergency room visits can lead to surprise medical expenses

Going to the emergency room usually means that one is having a severe health crisis. Once there, one's thoughts are simply that the illness or injury is promptly and properly treated. And, for many in Long Island, this is the case as they are discharged and go home to rest and recuperate.

After one regains their health, however, an unwelcome surprise may arrive in the mail: a substantial medical bill for emergency room treatment. If one has health insurance that includes emergency room coverage, they may wonder how this could happen.

Well, what may have happened is that even though the hospital may have been in-network, the treating doctors may have been out-of-network.

In fact, two Yale researchers examined over two million emergency room insurance claims throughout the nation. The results of their research showed that about two out of 10 trips to an in-network emergency room involved a physician that was out-of-network for the patient. This is because emergency room physicians may work for the hospital on a contractor basis, so they may have different arrangements with insurers than the hospital does.

This also meant that the patient was left to cope with a hefty medical bill for what was not covered by their insurance policy. According to the researchers, the average medical bill in such situations was approximately $620. Emergency surgery often leads to an especially large bill, particularly if the anesthesiologist was out-of-network.

Unfortunately, if one was the recipient of a surprise medical bill, they may not have much of an opportunity to change it. They can try to have the claim processed a second time as there is no way to check beforehand whether a particular doctor at an in-network hospital would be out-of-network. And, one could also attempt to negotiate to reduce the bill.

The good news is that in New York, there are laws on the books that protect patients from surprise medical expenses, at least in part. However, that does not mean that unpaid bills will not add up, particularly if insurance coverage is lacking. When this happens, one might want to learn more about how filing for bankruptcy can help eliminate debt.

Source: CBS, "Surprise doctor bills from ER can add angst to injury," Nov. 17, 2016

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