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“Surprise” medical bills

Patients speak out about outrageous and unexpected medical bills

“It was very traumatic”

Scott Olsen

…became a victim of surprise medical billing after he took his wife to the emergency room in September 2018. She’d had surgery and woke up in the middle of the night with shortness of breath and chest pains. They feared a blood clot.

“The emergency was real,” Olsen told the Utah Legislature’s Health Care Reform Task Force.

Months later the couple, who live in Sandy, Utah, received a hospital bill for $8,091.98. Their health insurance paid $5,104.35. But the hospital came after the Olsens for the $2,987.63 balance.

There was no room for negotiation, Olsen told lawmakers.

Surprise, or “balance,” bills often happen when patients go to a hospital they think is in their insurance network, but are then seen by a doctor or specialist who isn’t. The patient is then on the hook for an often very high bill – sometimes exceeding thousands or even tens of thousands of dollars.

Recent studies suggest that “surprise” bills are relatively common. Today, 1 in 5 patients seeking care in a hospital emergency room may be unknowingly treated by an out-of-network provider. More than half of all ambulance trips in 2014 involved out-of-network companies.

An August 2018 survey conducted by researchers at the University of Chicago, found 57 percent of American adults have, in fact, received a surprise medical bill.

Luke Rowley

…rushed his wife, who was seven months pregnant to the emergency room in October 2018. Their newborn daughter spent two weeks in intensive care.

Shortly after they brought their baby home, the Rowleys received a bill for $84,000. They had insurance but still owed $50,000.

With a lot of help, the Rowleys negotiated their surprise bill down to $3,000.

“It was very traumatic, Luke Rowley told Utah lawmakers, adding that no family deserve to face such financial stress.

Lawmakers across the country are hearing horror stories from families demanding relief. Twenty-five states have passed laws in recent years to restrict balance billing and protect consumers from excessive and unexpected charges.

A new Oregon law banning surprise bills took effect in 2018. But it only applies to out-of-network charges and to insurers regulated by the state. Lawmakers in Washington State are trying for the fourth time to find consensus around legislation that would protect consumers from huge and unexpected out-of-pocket costs.

Utah State Rep. Jim Dunnigan, R-Taylorsville, has spent the past few years working on a solution to surprise billing in his state. He crafted state bills in 2018 and 2019, only to see them stall. Dunnigan is hopeful that the federal government can push legislation over the finish line.

“Every week I get people who contact me with their stories,” he said.

There was a man that Dunnigan grew up with who had a heart attack at age 55 and sought help in an out-of-network ER. The total bill: $210,000. After insurance, he still owed $150,000.

A woman told Dunnigan that her surprise bill was so high that the hospital offered to put her on a payment plan in which she’d write a check for $6,000 every month.

An insurance agent and co-chair of the Utah Legislature’s Health Reform, Dunnigan does what he can to help individuals and families deal with their outrageous charges. He was able to save one woman $30,000, Dunnigan said. “But I can’t do this alone.”

President Trump and U.S. senators from both parties say they’re ready to tackle the issue. They’ve proposed a variety of remedies that include prohibiting providers from charging out-of-network costs unless the patient is notified in advance and consents to pay. Other proposals would set limits on out-of-network charges.

The pressure mounts as a flood of consumers are coming forward to share their stories.

Surprise Medical Bills facts and cost

Paul Davis,

…a retired doctor from Ohio, joined nine other guests invited to the White House in January, 2019. His family’s story was first reported by Kaiser Health News.

Davis’s daughter Liz Moreno underwent an operation to address debilitating back pain. She didn’t give it a second thought when the surgeon’s office asked her to leave a urine sample for a drug test.

Then the bill came. It was $17,850, from a laboratory outside her insurance network. Similar tests typically cost no more than $200.

In the end, to protect his daughter’s credit, Davis paid the $5,000 to settle the bill. Then he filed a complaint with the Texas attorney’s office accusing the laboratory of “price gouging of staggering proportions.”

Will state or federal officials finally get families some relief from surprise medical bills? Maybe. Here’s what Christopher Garmon, an economist at the Federal Trade Commission, told Voices for Affordable Health two years ago:

“It’s clearly a consumer protection issue.”


Tips for consumers

Do your homework:

  • If it’s not an emergency, take time to make sure the physician, lab or hospital you are about to visit has an in-network agreement with your insurer.
  • Ask for a cost estimate before getting elective surgery or other planned care. Make sure to also ask whether any member of your health care team will be out of your insurance network.
  • If a doctor or hospital is not in your network, ask if they will accept your health plan’s payment as payment in full.

Don’t panic:

  • Before you pay a bill you didn’t expect, contact the hospital, lab or doctor’s office and make sure the dates and charges are accurate.
  • If a bill is much higher than originally estimated, ask the provider to lower the charge.
  • Contact your insurance company to make sure there are no errors or outstanding reimbursements.
  • Don’t forget that hospitals and other providers may be willing to negotiate the bill and/or payment terms.
  • If you still think the charges are unfair, file a complaint with your insurer or state consumer protection office.