How to Dispute Surprise Medical Bills

Last edited Tue Nov 22, 2022, 09:43 AM - Edit history (1)

In October, I received a doctor’s bill for $21,500 for treatment my daughter received in the emergency room of a local hospital after suffering a one-inch cut on her forehead. I remember opening the bill while walking down my driveway and nearly having a heart attack: How could 10 measly stitches possibly cost more than 20 grand? And why were we being billed for services we’d received at a hospital that was in our insurance company’s network?

I’m one of many Americans who have had experiences like this. A 2020 report from the Kaiser Family Foundation, a nonprofit organization that focuses on national health issues, found that nearly one in five emergency room visits and up to one in six in-network hospital stays prompted an unexpected out-of-network medical bill.

These bills arise because even if you visit an in-network provider, you can still be treated by an out-of-network physician who works there, said Karen Pollitz, the co-director of the Kaiser Family Foundation’s Program on Patient and Consumer Protections. “The doctors who work in hospitals generally don’t work for the hospitals,” she said. “They bill independently, and they can decide which networks they participate in.”

In January, a new federal law called the No Surprises Act went into effect, aiming to prevent health care providers from sending surprise bills to people with private insurance. (Protections like this were already in place for people with Medicare, Medicaid and Tricare.) But “the hospitals don’t always comply,” said Marshall Allen, the founder of Allen Health Academy, a health literacy organization, and the author of “Never Pay the First Bill.” So surprise bills are still a problem. And bills for medical care provided before 2022 — like my daughter’s stitches — aren’t covered by the law, either.

https://www.nytimes.com/2022/06/30/well/live/surprise-medical-bills.html