After a car wreck, you are often rushed by ambulance to an emergency room for immediate treatment. Before the ambulance arrives or later as you lay in the ER bed, you assume that your Aetna or Blue Cross will pay for all of your bills, right?
No, not necessarily. It’s a complicated system that is extremely anti-patient for these reasons:
- If your health insurance plan should decide to pay the bills, it usually files a lien and demands full reimbursement from your car wreck settlement or verdict.
- Your hospital may be out of network,
- Your Aetna plan may say that it is secondary to the at-fault driver’s primary auto insurance policy and refuse to pay anything, and/or
- You may not have met your annual deductible or have a large co-pay.
You won’t know this until later. Much later. What happens then?
You are stuck paying for $10,000 and often more of medical bills. You take it for granted that the other driver’s insurance company will reimburse you in full, and still give you plenty of extra money for your lost wages, pain and suffering and other damages.
Good luck if you don’t have an experienced personal injury lawyer on your side.
And to make matters worse, the emergency room department will also generate a separate bill which runs from $500 to $3,000 or more. This may also not get paid for the above reasons.
The hospital will file a lien so they get paid in full — or has the lien reduced by your attorney. Take a look at horrible story in today’s paper about a Good Samaritan who just had a $151,000 hospital lien filed on her after she had to have her legs amputated.
And a new bill has been approved by the Texas Senate that unfortunately allows emergency room physicians to also file a lien for their bills that must be paid from the proceeds and clarifies that any ER admission qualifies for the payment. SB 2066 will further reduce the amount of money an injured person will receive for his damages and I hope it does not get passed by the Texas House of Representatives and signed into law.
But at least there’s a little good news. State lawmakers just passed a bill that gives patients some recourse. The bill does not go as far as I would like but it is a good start to resolving this ludicrous system that hurts Texans. I urge Gov. Abbott to sign SB 507 so it becomes law.
You Can Be Billed Separately for the Hospital and Emergency Room Doctors and Specialists
The present insurance scheme is organized price-gouging. It allows these companies to supposedly pay for hospitalizations, but wiggle out by classifying as out-of-network its emergency room physicians, surgeons, anesthesiologists, radiologists, and other medical professionals who are part of your medical treatment.
Making sure every single doctor you come into contact is impossible, especially if you are being treated in an emergency. Even if you were aware of the unfair policy, you don’t have the option of waiting for an in-network doctor to come to treat you.
How the Law Will Help Patients
Since 2009, the Texas Department of Insurance has managed a mediation program to help insurance carriers and their policyholders resolve surprise medical bills. However as it stands now, that program is very limited. The rules only apply to certain specialties and the program is only available to PPO policyholders. That leaves out huge segments of Texans who are covered under HMOs and other types of policies and still leaves patients on the hook for certain types of doctor care.
The new law expands this effective mediation program to include more policyholders and gives patients the opportunity to contest bills of more than $500 sent from any out-of-network provider that works at an in-network hospital or urgent care clinic.
What Are Your Options When You Receive an Out-of-Network Bill?
You aren’t likely to learn that your treating physicians were out-of-network until weeks later when you receive the bill. What do you do?
First, don’t panic and definitely don’t pay it. Consult with a personal injury lawyer who can explain your options.
Thanks to this new law, the TDI mediation program can be an invaluable resource for him to help you reduce or even eliminate the bill.
I already represent clients during litigation or pre-lawsuit negotiations to obtain medical bill reductions and am happy to have another tool at my disposal.
Please contact me if you have any questions about how I can help you get the compensation you deserve.