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Insurance Consumer Advocate

Sha'Ron James

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Saturday Lead Letter: Patients need protection from surprise hospital bills


Date: March 10, 2017
Source: The Florida Times-Union
Author:  Mark Ryan


After dropping a check for $190 in the mail for the prolene mesh, I finally made the last co-payment for my recent hernia surgery.

Florida Blue federal employee insurance had covered the $443 difference for the body part.

A 4-by-6 inch piece of mesh for $633? No wonder health insurance is so expensive. I’m half expecting to get a phone call from a sales person wanting to sell me an extended warranty.

But I shouldn’t be complaining because my financial responsibility for the herniorrhaphy — overdue by 15 or 20 years — was basically a bargain at $490.

The seemingly never-ending wave of separate bills makes planning very difficult.

I hadn’t anticipated the mesh bill despite researching costs in advance with the insurance provider, doctor’s office and outpatient surgical center.

A Consumer Reports National Research Center study (2015) indicated surprise medical bills are not unusual.

The study, which included 2,200 adult U.S. residents, found that 30 percent of privately insured Americans received an unexpected medical bill as the result of their health plan paying less than they expected.

A Yale University analysis of claims data from clients in 50 states (2016) found that as many as 1 in 5 emergency room patients treated in an in-network hospital received a bill from at least one out-of-network physician.

Florida has done more than most states in protecting against so-called “balance billing,” which is the practice of out-of-network health care providers directly billing patients for the balance remaining on the invoice after the insurance company pays its part.

In 2016, Florida passed legislation that expanded balance-bill prohibitions relating to out-of-network medical billing for visits to emergency rooms and other facilities if the patient did not have the ability or opportunity to be treated by an in-network provider.

I would eliminate all the separate billing. I’d propose insurance providers implement the up-front protocol commonly used with car repairs.

When you need to have a brake job done, you sign a written agreement that the repair will not exceed the mechanic’s maximum-cost estimate.

In one hassle-free conversation, the Florida Blue representative would have told me the following:

“The total out-the-door cost to repair the hole in your lower abdomen is $490. That includes everything.”

Thankfully, Florida Blue paid $3,455.

Without insurance, the surgery — an outpatient procedure less than four hours in duration, mind you — would have cost me $8,950.

And without insurance, I would still be lugging around that puffy old hernia.

Mark Ryan, registered nurse,