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The Painful Problem of Surprise Medical Bills

If you've gotten a bill from a doctor you've never heard of, you're not alone

You know your surgeon’s in-network, but what about your anesthesiologist? What about the doc performing an emergency procedure? Is she covered by your insurance?
Often the answer is no.

PBS NewsHour recently delved into the problem of surprise medical bills and shed light on a painful problem that is remarkably widespread: Patients going in for a medical procedure they believe is fully covered by their insurance only to get socked with an unexpected bill for thousands of dollars from a doctor they’ve never heard of. (It’s a problem that Next Avenue has written about, too.)

“Last year, Consumer Reports found 30 percent of Americans with private health insurance have received surprise bills, where their insurance plan paid less than they expected,” reported NewsHour. “Of those, 23 percent received a bill from a doctor they didn’t expect to get a bill from. And 14 percent said they were charged higher out-of-network rates by doctors they thought were in-network.”

Narrow Networks

In the segment, reporter Megan Thompson spoke to Chuck Bell, programs director at Consumers Union, the advocacy arm of Consumer Reports, about a problem he says is on the rise.

Thompson reported that “one reason for surprise medical bills may be that insurers are increasingly offering “narrow networks” — cheaper insurance plans that give patients fewer doctors to choose from.”

That may help explain the hundreds of sad submissions NewsHour collected when it asked viewers to submit their personal stories.

Stories like these:

  • A woman from Idaho, who received a bill for $26,000 after getting letters from her insurer approving her cervical discectomy fusion procedure as well as her surgeon and hospital.
  • A man who spent 30 days in a rehab facility that he was told was covered only to be billed $40,000.
  • A woman from Michigan who required an emergency thoracotomy and says her surgeon’s bill alone is $10,400.

“When you actually go to a hospital or an emergency room,” Bell told Thompson. “You inevitably run into physicians and providers that are out-of-network, and then those costs quickly mount up.”

To read more stories about surprise medical bills or submit your own, go here.

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