When Insurance Coverage Doesn’t Stop You From Being Billed

Just because a doctor is in-network doesn't mean everyone they work with is

Hospital
Even the most well-prepared of patients can still deal with unexpected medical bills.
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By Tobias Carroll / February 12, 2020 7:00 am

The world of surprise medical bills is a particularly fraught one, and it has drawn attention from journalists and lawmakers alike. It also factors into a larger conversation about medical debt, which has created its own fraught situations in recent years. For many people, ensuring that they’re not caught unawares by a surprise bill can involve plenty of research into whether certain doctors and hospitals are covered by their health insurance.

A new article at The Atlantic by Olga Khazan offers an unsettling perspective on when surprise billing can occur. Hint: not even people who go to a doctor and hospital covered under their insurance are safe. Khazan cites a study in the Journal of the American Medical Association which outlines one way in which  the causes of surprise bills can happen: by literally making their approach when a patient is unconscious.

They happen about a fifth of the time that a patient has an elective surgery at an in-network hospital with an in-network surgeon. Having a surprise out-of-network bill raised the total bill by an average of $14,083. The dollars racked up while many patients were unconscious, and an out-of-network specialist simply walked into the room.

The study reviewed the experiences of over 300,000 people and spanned the years 2012 to 2017. Doctors’ assistants and anesthesiologists were among the two positions where out-of-network charges piled up. While a particular surgeon might be within a patient’s network, the anesthesiologist they’re working with might not be — and that’s just one example in a complex medical system.

There are no easy answers to this dilemma, but the results of this study might at least help some patients be more prepared — and it might help policymakers find a solution to another aspect of an ongoing crisis.

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