facebook What happens when your insurance plan is “out-of-network” with the largest ER in your city?

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What happens when your insurance plan is “out-of-network” with the largest ER in your city?

It’s a familiar story for many. You have an accident. You have insurance. All is well and you’re happy to be alive. But like Nina Dang, who suffered a broken arm after her bike skidded on some rough pavement, months later you receive a bill for tens of thousands of dollars.

Vox recently reported about Dang’s experience, and others, at Zuckerberg San Francisco General Hospital. Named after the Facebook founder for his $75 million donation, it is the largest public hospital in the city and the only top-tier trauma center.

According to Vox, most big hospital emergency rooms negotiate prices for care with major health insurance providers and are considered “in-network.” Zuckerberg does not participate in the networks of any private health insurers because it has not done the necessary bargaining with private plans. This makes many insurance plans considered, “out-of-network” and leaves many insured patients with a large bill.

Robert Berman with medical billing advocacy firm, Systemedic told Vox: “It’s really unusual for this to be the case. Usually, it’s the doctors who are often out of network. For the ER to be out of network? That’s a bit odd.

This, combined with that fact that Zuckerberg is the largest public ER in the city, creates a problem for residents. When an ambulance takes you to a hospital in an emergency, you have little to no say on where you are taken. And even if you could decide, it is unlikely that you and your loved ones are in a mindset to research and choose an in-network facility.

Brent Andrew, a hospital spokesman, told Vox that he realizes the hospital’s insurance policy can leave patients like Dang in a tough place. The hospital’s focus is on serving those with public health coverage, he said, even if that means offsetting those costs with high bills for the privately insured.

“We’re the trauma center for the whole city. Our mission is to serve people who are underserved because of their financial needs. We have to be attuned to that population,” said Andrew.

Christopher Garmon, a University of Missouri Kansas City economist, says it is rare for major emergency rooms to be out-of-network with all private health plans. Just 1 percent of ambulances end up at out-of-network emergency rooms, and most other public trauma centers visibly display a long list of health insurance plans they accept on their website.

In 2009, Zuckerberg San Francisco General patients filed a class-action lawsuit against the hospital seeking relief from these surprise out-of-network bills, but the judge ruled against the patients, finding that the hospital’s behavior was legal under California insurance regulations.

Have you been surprised by a hospital bill? Share your story at Voices for Affordable Health.