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Insurance Consumer Advocate

Sha'Ron James


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Family stung by surprise medical bills

News Article

May 24, 2016

KWWL ABC-7

NBC News - Sienna D'Andrea was just two months old when she had emergency heart surgery at a New York hospital.

It went well, bu tafter the procedure, the family faced another emergency: the medical bills.

In total, more than $100,000 in bills were sent to the D'Andreas' home. Many of these bills were total surprises because the family thought their hospital was in their insurance network.

The family had insurance, but was told it didn't cover everything in the emergency department, and the family had to pay for hospital supplies, assistant surgeons, and X-ray technicians.

Consumer advocates point out that this is an all-too-common problem. According to Consumer Reports, nearly one third of Americans who have visited a hospital in the last year have received a surprise medical bill. In Texas, more than 20 percent of hospitals considered in-network by the top 3 insurers had no in-network emergency room doctors on staff.

Legislation has been passed in New York and Florida that excludes the consumer from surprise medical bills, and requires the insurance company and healthcare provider to work it out when the consumer's surprise out-of-network payment exceeds the deductible covered by the insurance company.

"This new law protects consumers by holding them harmless in times of both emergency situations when choosing a provider is not an option, and in non-emergency situations," says Jeff Atwater, the state of Florida's chief financial officer.

The hospital industry says that insurers should bear the responsibility when it comes to covering enough doctors and clearly identifying who they are. And the insurance industry points its finger at doctors who don't accept enough plans.

"These state-based solutions are helping provide consumers with needed relief, as well as offering an outlet to amicably settle out-of-network bills," said Rick Pollack, president and chief executive of the American Hospital Association.

"Any proposals to address balance billing should address the core issues at hand — lack of transparency and excessive charges billed by certain specialists and doctors who choose to forego participation in health plans' networks," a representative from America's Health Insurance Plans, a trade association that represents health insurance companies, told NBC News.

In the case of baby Sienna, her mother and grandmother stepped in to help shoulder the hefty bills. Sienna's grandmother quit her job to work on negotiating the medical bills directly with the hospital, and was able to talk them down from $100,000 to just $10,000.