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Putting A Face To Surprise Bills

Sep 2019

Surprise out of network medical billing continues to plague patients all across our nation. Even though Bob Ensor was rushed to an in-network hospital, he was treated by two out-of-network plastic surgeons. Ensor then incurred over $167,000 in out of network bills from the surgeons his health insurer denied. Emergency situations seldom allow patients to check network coverages, and in this case the hospital knew the surgeons were out-of-network, but did not provide this information. The general lack of pricing and in or out of network doctors information in healthcare is an issue Medxoom can help employers with by educating patients to always ask doctors if they are in or out of network before getting treatment.

From Kaiser Health News:

“As surprise out-of-network billing becomes a politically charged issue, Americans want the federal government to take action. In an April survey, more than three-quarters of consumers said the government should protect them from such bills, according to the Kaiser Family Foundation’s monthly health tracking poll.

An analysis of insurance claims from more than 350 commercial carriers found that plastic and maxillofacial surgeons billed out-of-network more frequently than any other type of specialist in an inpatient setting. Examining hospital admissions in 2016, researchers at Johns Hopkins Bloomberg School of Public Health found that plastic and maxillofacial surgeons billed their services out-of-network 23% of the time, more than any of the other 50 specialties analyzed.

That leaves patients like Ensor, whose care requires plastic or maxillofacial surgery, extremely vulnerable. It also catches patients off guard: When a parent brings in a child with a cut and a triage nurse asks if they’d prefer a plastic surgeon, many reflexively answer “yes” not understanding whether there is an actual need nor anticipating the charges.”

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