As a Rockville resident, you have access to some of the best health care in the world. Johns Hopkins Hospital is an hour away, and, if you have private insurance, chances are good your hospital stay will be covered.
Or will it?
If you look at the hospital’s website, you will find a long list of managed care plans that are under contract. But there is one paragraph in the middle of the page that you could easily miss, much to your detriment. It says: “Please be advised that there may be certain services provided in our facility which are not covered by our contract with your plan. Please inquire with your health plan before calling to schedule an appointment.”
That paragraph could mean the difference between manageable costs and piles of unpaid medical bills. But don’t feel bad if you missed it and are now wondering how to handle the debt: According to a new study, you are one of about 3 million Americans who have unwittingly gone out-of-network for your medical care.
The researchers found that only about 8 percent of U.S. patients use out-of-network providers. They also found that 40 percent of those patients didn’t realize they were doing that.
In some cases, the out-of-network charges came from an emergency situation. For example, when preparing for the birth of a child, a woman chooses an obstetrician and a hospital she knows are in her network. Things don’t go as planned, though, and the baby ends up in the neonatal intensive-care unit.
Once the baby is home and everyone is settling in, the bill comes. Only then does the woman find out that the NICU doctors and even the anesthetist who administered her epidural were not in her network. When she and her baby were receiving the care, she didn’t think to ask — nor should she have to, the lead researcher adds.
The study shows the in-network versus out-of-network provider dilemma as yet another flaw in the system of care, and it may not be a flaw addressed by any existing or pending legislation. For patients, the best advice is to ask as many questions as possible beforehand. When the bills arrive, if you cannot handle them, you may want to contact an experienced debt relief or personal bankruptcy professional.
Source: Modern Healthcare,”Study details patients’ financial burden from unexpected out-of-network costs,” Beth Kutscher, June 14, 2013