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Insurance Consumer Advocate

Sha'Ron James


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Mailing: 200 East Gaines St.
Tallahassee, FL 32399-0308

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New state law will prevent unprecedented ER bills

 

Date: June 27, 2016
Source: WFTV9 Orlando
Author:   

 

A DeLand woman claims she was hit with a surprise emergency room bill even though she was fully insured.

Linda McCallister was charged nearly $1,000 for an "out of network" hidden fee.

She called Action 9 for results, and Todd Ulrich found out a new state law that protects all patients from surprise billing goes into effect this week.

McCallister, a nurse, thought she knew the right question to ask heading to the emergency room in severe pain.

“I called to make sure this hospital was in my insurance network,” she said.

Florida Hospital Deland was “in network” for her United Health Care coverage.

But later, McCallister got a bill in the mail for the emergency room doctor and the charge was $946.

“I thought everything was covered. I had no idea anyone would bill me,” she said.

The hospital was in network but the emergency room doctors were not.

United Health Care denied the claim.

“I discovered it happened to a lot of people,” she said.

Since 2011, Action 9 investigated a dozen cases involving families hit by out of network medical bills.

Starting July 1, a new Florida law will ban surprise charges and make all emergency treatment in network.

The reform protects patients who cannot be billed.

The doctors and insurance companies must now resolve the disputes on their own.

Florida's Insurance Consumer Advocate Sha’Ron James said it's a big win for many patients.

“The consumers needed to be taken out of this situation. It’s definitely a situation that should be resolved between providers and insurance companies,” James said.

When McCallister’s attempt to dispute her bill failed, she called Action 9.

After Ulirch contacted Emergency Medicine Professionals, the company dropped the charge, even though McCallister was billed before the rules changed.

An EMP spokesman said it had sent United Health Care all the documents it required, but it still didn’t pay the claim.

Starting Friday, patients will only have to pay their deductibles for emergency medical treatment.

Action 9 was able to help McCallister even before the reforms became law.

“You have been a big help. I didn't know where else to turn because no one was helping me,” McCallister told Ulrich.

The new law does not cover air ambulance charges.

James said consumers should still dispute the fee and contact her office.