NEWS 8 INVESTIGATES
More of us than ever have health insurance. So why do we seem to be paying more than ever for treatment?
News 8 Investigates uncovered a growing problem with medical billing.
It involves patients charged hundreds, sometimes thousands of dollars, in surprise fees after going to an in-network hospital.
Steve Parker is a physical therapist in Richardson. Over the years, he’s owned several PT clinics and says he understands the intricacies of medical billing and insurance. Yet even Parker admits he was recently taken for a ride by the system.
“I was at home and having some heart arrhythmia so I went down to the E.R.,” he said.
Parker went to an in-network emergency room. He was treated by a doctor for a minor condition. He paid a $100 co-pay and was sent on his way.
Then, a few months later, he got a bill for $1,300. It was from the doctor who treated him. As it turns out, unbeknownst to Parker the doctor didn’t work for the hospital, and that means Parker’s insurance didn’t fully cover that doctor’s fees.
“It just doesn’t make sense,” Parker said. “That’s the person in your face when you’re there. It’s the face of the emergency room and they don’t work for the emergency room – they work for a company out of Philadelphia.”
It has happened to Parker twice in the past year. He refuses to pay, and now a collection agency is after him.
“It’s like you went to a restaurant, paid a lot of money for this beautiful meal, and two months later, the cook sends you a bill because he didn’t work for the restaurant,” Parker said.
A national investigation by our partner TEGNA stations has found thousands of similar complaints of patients stuck with surprise medical bills across the country.
“If you’re in an emergency situation, you should never have extra bills that you weren’t expecting,” Brian Rothstein told KING-TV in Seattle.
“It’s not right,” Anastasia Galinato told WVEC-TV in Virginia. “They should say something to you.”
Here’s how it happens:
You pick a hospital in your insurance network, so you assume everyone in that hospital is also in your network.
But you are not told that the surgeon who treats you is out of your network and not covered by your insurance.
Also, you find out later, the anesthesiologist who sedates you is out of your network.
Then, that special tool the surgeon needs to perform your procedure is not covered by your insurance, either.
Days later, you get a bill in the mail for all three. You’ve just been hit with surprise balanced billing.
And it’s all legal.
“And there’s nothing in the law to stop it,” said Stacy Pogue, a senior policy analyst at the Centers for Public Policy Priorities.
Last year, the Austin-based bipartisan group studied surprise balanced billing. They found that, with some insurance companies, as many as 50 percent of the Texas hospitals in their networks did not have a single doctor on staff covered by a patient’s insurance.
“There’s very little planning somebody can do in advance around an emergency,” Pogue said. “That’s why we need good laws in place to protect consumers in emergencies.”
At least 24 states, including Texas, have some kind of limited protection to help consumers prevent or pay surprise medical bills. A Texas congressman, though, wants a federal law to make surprise billing illegal in all states.
In 2015, U.S. Rep Lloyd Doggett, D-Austin, authored the “End Surprise Billing Act.”
If passed, it would prevent balanced billing during emergencies; provide 24-hour notice of out-of-network providers, and provide consumers with a cost estimate.
“I think when patients go out and they’re responsible, they get insurance [and] check to be sure they are going to an in-network hospital, they ought not to have to foot a bill that is the result of a conflict between hospitals, insurers and physicians,” Rep. Doggett said.
Industry trade groups, like the American Hospital Association, would not say whether it supports Doggett’s bill. Instead, they told us they support a “structured mediation” model. But, that’s only after that surprise bill arrives in the mail.
For now, patients will continue paying for a system that doesn’t allow them to plan financially for their health care.
“There should be some kind of statement from the hospital that says, ‘If you come to our facility and we are in-network with your insurance, everybody in the facility has to abide by that contract,’” Parker said. “It only makes sense.”
The Texas Department of Insurance offers help to consumers with insurance billing problems. Since 2012, they have helped return more than $1.5 million dollars to consumers with balanced billing complaints.
Here’s what you can do.
+ File a complaint. In 2015, the Texas Department of Insurance processed 69 balance billing complaints and helped recover $490,518 for Texas consumers.
+ Request mediation. In 2015, of the 1,039 requests for mediation, only 68 were unresolved and referred to the State Office of Administrative Hearings. Ninety four percent of mediations were successfully handled at the first stage.
Mediation is available to most Texas consumers with health insurance, except for those on plans regulated at the federal level. While most consumers will have the “TDI/DOI” designation on their health insurance card (indicating state regulation by TDI/Department of Insurance), state workers insured through the Employee Retirement System of Texas may or may not have that designation but still qualify for mediation.
KVUE investigative reporter Andy Pierrotti contributed to this story.
We said things like this were going to happen under IdiotCare and we were called crazy, morons, tin foil hat wearing nutters. Well, we don;t look so crazy now do we?
F’N doctors aren’t greedy, they put themselves way above that. I know, I saw it every day, most are total pigs, you would be appalled to hear what they say about patients during treatment planning. You are a talking piece of meat, maybe gonna get gutted looking for whatever, it’s the procedure that produces the revenue, whether you need it or not.
Cha-ching, cha-ching, hear that money rolling in? And don’t even get me started on the F’N Health Maintenance Organizations. What a racket.
I shouldn’t really be disappointed with the status quo. It’s a “dog eat dog” world. F the next guy, right?
“How was you day, honey?” “Well, I stood by the school and stole the kid’s lunch money, hooked up with a couple baloney sandwiches, two peanut butter and jelly sandwiches I’m savin’ for later. And, I stole candy from a baby!” “How was your day?”
It really appears to be people’s attitude in today’s society. Everyone’s out to F the next guy. I’m sick of slicksters. Weasly joo behavior has permeated our culture and most seem to adorn the “crook nose.” I guess once you get F’ed over, it becomes infectious. Jooitis, it’s a disease, rotting souls from the very core. Resist this vile infection with all of your being or become assimilated, like the “Borg”.
“For now, patients will continue paying for a system that doesn’t allow them to plan financially for their health care.”
Which doesn’t even PROVIDE legitimate health care.