|Date:||December 08, 2016|
PALM HARBOR, Fla. - The last thing someone who just went to a hospital for an emergency wants is a "surprise" hospital bill, but that is what many patients are facing, including many in the Tampa Bay Area.
"It's just damn unfair," Tom Pascale of Palm Harbor tells ABC Action News.
Pascale's recent trip to an Emergency Room cost him over $1600, even though the visit was set-up by his primary care doctor and was in his insurance network.
A sub-contracted doctor he briefly spoke with atMeaseCountryside Hospital was apparently "out-of-network," and so the company billed him the outrageous rate.
His insurance company tells Pascale there's nothing they can do.
"I was shocked," says Pascale. "I've been arguing, fighting, writing letters."
Turns out, 1 in 5 ER patients experience a similar problem called "surprise" hospital bills, according to a recent report by researchers from Yale and published in the New England Journal of Medicine. The average "surprise" charge sets patients back an average of $622, according to that report.
Citing that report, Florida's U.S. Senator Bill Nelson penned a letter to the Federal Trade Commission, which prohibits "unfair or deceptive acts of practices in or affecting commerce," and urged the FTC to investigate the issue to ensure consumers are protected against surprise out-of-network bills.
"The Commission should consider whether these 'out-of-network' charges should be banned altogether in cases of emergency treatment when a consumer has no other viable choice for treatment options," writes Senator Nelson in the letter dated December 1, 2016.
"Not everybody is really able to think about everything during an emergency circumstance, and if they're lucky enough to get home, the last thing they need is a large massive surprise bill," says Mark Pafford to ABC Action News. Pafford is the CEO of Florida CHAIN, a health care advocacy group. He was also a state representative when Florida's legislature passed protections against "surprise" hospital bills for consumers in Florida.
The new law is supposed to provide a "resolution process" for consumers like Pascale, but so far, the only resolution he's told is available to him is to pay.
"It's not very patient-friendly," says Pascale.
A spokesperson for MeaseHospitals tells ABC Action News that they "understand" insurance coverage problems can create a "difficult situation" but didn't provide a remedy for Pascale, only encouraging him and others in this position to make a payment plan.
"We advise patients to take care of their emergency first," the Communications Manager for Morton PlantMease Hospitals tells ABC Action News, adding, "It’s common and the best use of resources for hospitals to contract with separate physician groups to provide emergency care. Most of the hospitals in the area follow the same practice."
"We encourage physician groups to align with the same insurance plans that the hospitals contract with, but not all do."