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Bob Ensor didn’t see it coming. He was cleaning a sailboard in dry dock when the boom swung and hit him in the face.
The 65-year-old man was rushed by ambulance to a hospital near his home in Middletown, N.J., where X-rays showed his nose and several bones of his left eye socket were broken. The emergency room doctor summoned an on-call plastic surgeon who admitted him to the hospital and scheduled surgery for the next day.
Six weeks later, Ensor was recovering from the 90-minute surgery when he got a call from a collection agency wanting to know how he planned to pay the $71,729 bill from a second plastic surgeon who’d assisted with the case.
While the hospital was part of Ensor’s health insurance network, neither of the two plastic surgeons who had repaired his face were. Ensor had no idea, and now faced more than $167,000 in so-called “surprise” out-of-network charges.
Ensor’s story was reported by Kaiser Health News as part of an ongoing series on out-of-network billing. An April 2019 public opinion survey by the Kaiser Family Foundation found more than three of four Americans want the federal government to protect patients from unexpected out-of-network charges when they are treated during a medical emergency.
More than two dozen states have passed laws that address some aspect of surprise billing, and Congress continues to debate what steps to take on a national level.
But what happens to patients in the meantime? Enso was fortunate to receive help from his sailing club. Since members were required to volunteer on work projects, the club’s insurer agreed to cover the accident as a worker’s compensation case, paying 100 percent of the plastic surgeons’ bills.
What can you do if you’re faced with a surprise medical bill? Voices for Affordable Health offers tips and more patient stories on its newly updated Surprise Medical Bills page. As always, we also welcome your stories.