If you’ve been to the hospital at any time in the last several years, it’s more than likely that you’ve been hit with bills that you never expected. Out-of-network doctors provide you with services that your health insurer will not cover or will only cover in small part. And, those services can cost tens of thousands of dollars.
Unless you have traditional Medicare, it’s hard to protect yourself from unexpected medical bills. Traditional Medicare covers all your hospital care. Health insurance through an employer or the Affordable Care Act or a Medicare Advantage plan almost always restricts your comprehensive coverage to in-network doctors and hospitals. But, they do not guarantee that only in-network doctors will treat you.
It’s no surprise that New York State’s Department of Financial Services reports that unexpected medical bills for out-of-network care are the biggest health-insurance related complaint they receive. Too often, hospital care includes services from doctors such as pathologists, anesthesiologists and radiologists who are out of network, for which patients have been wholly responsible. Consumers Union offers a case study in this report.
With a new law passed in March 2014, New York now leads the way in protecting patients in private health plans from these unexpected medical bills. Among several new protections for patients, out-of-network doctors must give notice to patients that they are providing services. Patients can then insist on receiving services from in-network doctors. Without this notice, patients are only responsible for the in-network cost, and insurers are responsible for settling disputes with doctors.
If you don’t live in New York, it is still worth telling the hospital that you only want to receive services from doctors in your health plan’s network. And, before surgery, repeat that request to ensure that the anesthesiologist, pathologist and radiologist are all in your plan’s network.
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