Surprise balance bills can be a financial catastrophe.
After being in a car accident, you smartly checked your health insurance policy and only went to an in-network hospital and doctor so that you would only have to pay a small copay. They assured you at the front desk that they would bill your Aetna plan.
Then a few weeks later you may have started screaming when you opened the mail and read whopping medical bills for thousands of dollars. It happens every day to people who are injured in collisions in Fort Worth and North Texas. Medical bills cause a staggering 643,000 Americans to file bankruptcy each year.
Here’s what causes enormous medical bills to happen:
- Even if you are even covered by Blue Cross, not every hospital and doctor is your plan’s network,
- Or you haven’t met your annual deductible yet, especially now at the beginning of the year,
- Or you may have a large deductible, say $5,000.00, and never meet it each year,
- Or the ambulance, hospital, doctor, or MRI facility refuses to file with the plan,
- Or the hospital files a lien and demands payment in full from you and your recovery from the other driver,
- Or the plan refuses to accept any claims, falsely claiming it is not required to do so,
- Or the plan slowly pays some of the bills and then bills you for the enormous balance still due and/
- Or the plan pays bills and demands subrogation (repayment) when you receive funds from the at-fault driver’s liability policy or another source.
This financial roulette is a catastrophe. Medical bills can be astronomical even if health insurance steps up and pays the bills in full. This process is unfair to Texans for so many reasons and must be reformed.
You can’t guarantee that every medical provider you saw and will see is in your network.The ambulance that showed up at the scene drove you to the nearest available hospital. By sheer luck, the ambulance and hospital might have been in-network, but the separate company’s emergency room doctor often is not. Even if you knew this (which isn’t likely unless you searched your plan documents first) you weren’t exactly in a position to demand to be transferred to a different hospital that was in-network. It’s a dangerous game of financial roulette and it can be ruinous to your bank account.
Why does it matter if the hospital is out of network? Because it will charge whatever it wants, many times higher than the negotiated insurance rate of your in-network one. So a $1,000.00 bill that should have only been $200.00 in the first place can be billed at $5,000.00 or more.
Guess who pays the difference — you. That is, unless you hire a good personal injury lawyer.
I regularly negotiate for the maximum possible damages as well as getting the lowest possible reductions for the medical bills of my clients. Success on both of these fronts is crucial for a successful outcome. After all, it doesn’t matter if you get more money from the other driver’s insurance policy if you have to hand all of your proceeds to hospitals and doctors. This is especially true if you had health insurance and should have been covered to begin with.