The Shady Side Of Healthcare
July 12, 2017If you’ve ever found yourself on the receiving end of an out-of-network medical bill, then you know the financial pain of realizing that having insurance is useless in that case, oftentimes despite your best efforts.
I learned this lesson early on — after a stray cat I rescued out of the grocery store parking lot bit me one rainy night in Cincinnati, my colleagues convinced me I needed a rabies shot stat, so I headed to the closest ER. That split second decision to go there instead of taking a moment to research an in-network urgent care center or emergency room ended up costing me $300, or $270 more than urgent care would have cost. As a 23 year-old new college grad struggling to find $25 to put in my savings account each paycheck, that was an expensive lesson.
Since then I’ve become a bit of a stickler about staying in network, going so far one time as making my husband walk home after being hit by a car on his bike so we could look up which hospital was in-network rather than calling EMS.
Balance billing despite your best efforts
The frustrating part is that despite best efforts, many of us will find ourselves on the line for a big medical bill for an out-of-network cost, even when we go to in-network providers for services 100% covered by insurance. One example is if you ever have a procedure in your doctor’s office that uses anesthesia, which I had last summer.
The doctor chooses the anesthesiologist, who is typically an independent contractor, and you have no choice in the matter who they use – you’d think if you’re using an in-network doctor at an in-network facility that you’d be sheltered from out-of-network issues. Sadly, this is wrong and I think it’s pretty shady. After I was “balance billed” to the tune of $955 for my procedure with no help from my insurance, I did some research.
Turns out this is a pretty common practice, according to Tom Torre, the CEO of medical expense management company Copatient. “Medical transport [ambulance services] and anesthesiologists are actually notorious for [staying out-of-network and charging patients outrageous amounts for services they didn’t have a choice but use],” he told me when I spoke to him earlier this year. Because you’re (hopefully) unlikely to be a repeat customer of either service, they really don’t care if you feel gypped by their billing practices — they intentionally stay out-of-network in order to maximize profits and they can bill you whatever they feel is fair for their service, insurance company limits ignored. Shady!
So what can you do?
Besides the obvious answer of doing your best to stay out of ambulances or needing surgery, the one thing I’ve learned over the past couple years of health issues is that no one else is going to look out for your financial well-being when you’re seeking medical care so you MUST do your homework and you have to know what to look out for.
Ask questions
When I learned that the same anesthesiology office was being used in procedures tied to IVF this month, I got right to work. First, I called my insurance to verify that I had coverage for anesthesiology and that the provider was indeed out of network. Then I called my IVF clinic to ask if I had any choice in anesthesiologists (I don’t). But the billing coordinator did tell me that they have a “self-pay” option where I pay the clinic versus being billed by the anesthesiology group via insurance. After verifying that the anesthesiology group’s bill would be much higher than the self-pay rate, I opted for that.
Try to strike a deal
Had I found that the self-pay rate was higher, then I would have negotiated for a discount through the anesthesiology group, which Mr. Torre tells me is typically about 20% (that was the outcome of my original dispute as well). The upside to this option would have been that even if my insurance didn’t help reduce costs, at least the amount would have applied to my out-of-pocket limits, so if you’re close to reaching that, you could end up getting help from your insurance either way.
What if it’s too late?
So what happens if you’ve already received the service and it’s too late to negotiate up front? Call the out-of-network provider and ask them for help. Often they will help you appeal to your insurance for some type of coverage (although it may just mean you’ll have their allowable amount added to your deductible) or at least help you set up a payment plan to ease the burden. Make sure you do this right away though, as these issues can take months to resolve and aged balances are often sent to collections regardless of where you are in negotiations.
If the best the provider can do is offer you a payment plan, ask for a discount before you agree. The billing rep may have to ask a manager, but it usually gets you something, especially if they know you’re on the hook for the whole amount. In my experience, setting up a payment plan directly with the provider is the best route to go, as they rarely charge interest as long as you pay on time each month.
It’s shady, but it is what it is
I wish I could say that there is some loophole that these companies are flaunting and that there is a way to get out of these charges, but there isn’t. It’s legal and it’s the dark side of our current healthcare system. The best way to protect yourself from bills like this sending your finances to pieces is to keep that emergency fund in place.
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