Just read about a woman who had surgery on her thumb to remedy the effects of arthritis that made using her thumbs painful. (“You Only Think You’re Covered,” by Haley Sweetland Edwards, p. 44, TIME, March 14, 2016). The surgery went well; she regained full use of the thumb and went ahead with the same surgery on her other thumb.
She had checked with her health insurance provider before the surgery to ensure the procedure was covered and the providers (surgeon and hospital) were in-network. The first surprise bill for $6,300 didn’t arrive until some time after she had the operation on her other thumb. Now she’s waiting for the second $6,300 surprise bill.
Turns out the anesthesiologist was not in network and the device implanted in her thumbs was not covered.
This morning my wife showed me a report from her health insurance provider listing several tests that had been performed on blood work done by an in-network laboratory. All but two of the tests were listed as in-network and resulted in modest copays. Surprise! The other two were listed as not in-network and carried the full charge. She has yet to receive a bill for this lab work, which was done several weeks ago.
What, if anything, can consumers do about surprise charges that arrive weeks and sometimes months later? I see the following alternatives:
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Just pay up and shut up, or…..
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Don’t sign the paper they give you that describes the extra charges that might be coming your way. This may delay your health care a while, but might be worth the wait.
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Request a list of all of the providers that may be involved in your procedure, preferably before you are wheeled into the operating room and sedated, so you can check to make sure they are all in-network. (Warning: watch out for in-network hospitals that have out-of-network departments.)
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Request the make and model of any devices to be used so you can find out whether your insurance will pay for them.
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For blood work, request a list of the tests to be performed and showing which are in-network, which are not, and the cost of each.
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Get all in-network promises and device approvals in writing, preferably a week or two before you are sedated.
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Ask whether there are any “facilities” charges that will not be covered by your health insurance.
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If you do all you can to avoid surprise charges and still get a surprise bill, ask for an audit of the coding that produced the charges.
Take action: appeal surprise charges. Complain. Change providers and hospitals. One can hope that at some point hospitals, doctors and insurance companies will some day all feel they are making enough money without hoodwinking their patients and customers, but I’m not holding my breath.
Good grief……
EinarJoeBohlin's Blog 
This is not a new problem. 23 years ago my, then 11 month old, son needed to have tubes placed in his ears, requiring anesthesia. I’d done my due diligence regarding what charges to expect. Beginning the night before I followed all the doctor’s instructions: starved my son since midnight; didn’t feed him in the morning; arrived at 7am for a 9am procedure; and waited patiently with a hungry child when I was told things were running late. We were finally taken back some time after 10am with my son now wailing in hunger at full volume! THAT’S when we were told that the anesthesia group was out of network AND they needed payment up front- RIGHT NOW- or the procedure could not proceed as scheduled. I tried to explain that, thanks to my son’s constant ear and upper-respiratory infections, we’d met our annual out of pocket maximum and that covered both in and out of network providers, so we would be covered at 100% and I had a copy of the pre-verification letter to prove it. They wouldn’t (or maybe couldn’t) hear it. Thankfully my mother was with me and was both willing and able to put the charges on her credit card. Turned out that the charges were, in fact, paid in full. I then had to spend MONTHS trying to secure a refund for my mother.
Here’s the irony- Mike just had to get a new CPAP machine for his sleep apnea. The story of how he got to the point of needing to purchase a new machine is a book in the inefficiency of our healthcare system on it’s own, but the company verified coverage and the machine was delivered. He paid his amount due COD and arranged for monthly payments for the next umteen months because, of course, he has to rent the machine until the purchase price has been paid. Then we received the paperwork from the insurance company. Turns out the provider is out of network, so we have higher copays to pay. Of course they knew that, but failed to mention to my husband that he could receive the same machine from an in-network provider for a considerably lower cost. I did fault my husband for not more thoroughly investigating the situation, but honestly, don’t we have the right to expect this type of disclosure from providers?
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*There are so many providers and insurance plans and procedures, and manuals, and formularies – very confusing and time consuming – agreed! Often the staff at the providers’ offices aren’t bright enough or resourceful enough to get the right answers.* *We just dealt with a “coding” problem. A procedure Karen has was incorrectly coded for the insurance company and we had to go through hell and high water to get that fixed….. *
On Wed, Mar 30, 2016 at 12:03 PM, EinarJoeBohlins Blog wrote:
> Tracie Loveless commented: “This is not a new problem. 23 years ago my, > then 11 month old, son needed to have tubes placed in his ears, requiring > anesthesia. I’d done my due diligence regarding what charges to expect. > Beginning the night before I followed all the doctor’s instructio” >
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Ask for a veteran’s &/or a hardship deduction; offer to settle for 10 cents on the $, then work out a long term payment plan. If all fail, threaten to report them to ISIS.
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