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.
How an attorney can help you reduce your medical bills
I have negotiated with insurance companies and medical providers for the past 37 years and am often shocked at what they charge, e.g. $3,000.00 for MRIs.
Here are some of the steps I take to help my clients on a daily basis:
- I carefully review bills for mistakes, then demand that they be rectified and rebilled,
- I demand the hospital or doctor reduce inflated bills,
- I demand that hospitals release wrongfully filed liens – just yesterday, we got three released by a huge chain,
- I set up a mediation conference call to negotiate balance bills,
- I negotiate reductions in bills, and
- Find them cheaper doctors and testing facilities in the first place.
New balance bill mediation is highly effective
Fortunately Texas law now offers some relief to this balance bill nightmare. For the first time in our state’s history beginning this past September, a person now has right to request a mediation between the insurance company, doctor, himself, and his car accident lawyer to negotiate bills of $500.00 or more. Before that, a highly restricted process allowed arbitration and then lawsuits on a limited number of claims.
Also starting a few weeks ago on January 1st, this right was expanded to include all of those new stand-alone clinics like CareNow where a simple visit can easily cost over $1,000.00. Starting on September 1st. they were finally required to post a list of which health insurance plans they (supposedly) did file on. The Fort Worth Star Telegram described how these free-standing ERs sometimes charge 10 times more than standard rates and how they “blind side unsuspecting consumers.”
The practice of balance billing is common in Texas. But 2,064 patients have heard of this new procedure and insurance companies agreed to pay $1.1 million and health care providers agreed to write off more than $6 million in bills last year.
What you can do to protect yourself from surprise bills
- Know which hospitals and doctors are in-network. Download your health insurance plan’s app to your cell phone and share it with your family members so you and they know your user name and password and can quickly access it.
- Ask up front if the facility is in-network before you go if possible.
- Get an estimate of any medical procedures that are planned in advance. Don’t forget to ask for all specialists, including anesthesiologists and other surgeons and therapists, who may also be involved in your surgery and rehabilitation.
- Shop around to find more reasonably priced doctors. We can help you do this.
- File a complaint with the Texas Department of Insurance. Their phone number is 1-800-252-3439.
These surprise bills must be avoided from the outset of your injury case. Once filed, the providers will first try to collect the bill themselves, then send them out to a collection agency which will ruin your credit. They will even sue you and take a judgment plus attorney’s fees, court costs, and interest that will be in your credit file for the rest of your life,
If you have been in a car wreck, I can discuss how this complicated process works during a free consultation.