Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I am just looking for some guidance here on what would be my best way of handing this. Last year I had an emergency and went to an in network emergency room. Luckily it was nothing too serious but they kept me overnight for observation.
Afterwards I setup a payment plan with the hospital to pay my deductible (I had a healthcare.gov insurance plan) and that was it. I watched as the hospital and doctors, both in network and out sent bill after bill to the insurance company, but I was paying my deductible and I knew that thanks to the Balanced Billing law signed into effect in 2016 I would not be responsible for any out of network providers who saw me while I was at an in network ER.
Almost a year later I am receiving a bill from an out of network Dr. who "observed me" (though I can't even remember having met the guy) for almost $3000.00
I have read and reread the balanced billing laws in Florida and everything says that if you go to an in network ER for an emergency, you are not responsible for the out of network providers bills if they are declined by the insurance company.
What can I do here? I feel as if this Dr's office is hoping I don't know the laws and just pay him. Is there a number I can call to complain or ask for a review of this bill to ensure I don't (or do) have to pay this bill?
My sister ran into this same scenario. NJ passed a similar Balanced Billing Act that went into effect in September. She called the office of the out-of-network doctor and was told the office was sending out bills for payment, even though the patients are not required to pay. She told my sister not to pay the bill. If I were you, and all of the medical treatments were performed after the Florida law went into effect, I wouldn't pay it. Save the bills in an envelope and stick them in your desk or kitchen "junk" drawer if you ever need to refer to the info on them ...just in case!
My sister ran into this same scenario. NJ passed a similar Balanced Billing Act that went into effect in September. She called the office of the out-of-network doctor and was told the office was sending out bills for payment, even though the patients are not required to pay. She told my sister not to pay the bill. If I were you, and all of the medical treatments were performed after the Florida law went into effect, I wouldn't pay it. Save the bills in an envelope and stick them in your desk or kitchen "junk" drawer if you ever need to refer to the info on them ...just in case!
This is bad advice and a good way to get the bills sent to a collection agency.
OP, call the doctor's office and find out whether they sent the bill to your insurance company. If not, ask them to call the insurance company and negotiate the fee. It is the insurance company that must cover you for out of network ER charges. If they already billed the insurance company and the ins denied the claim as out of network, call the ins company and tell them that they must cover the visit and should contact the doctor and negotiate the fee.
Have you gotten an Explanation of Benefits for that doctor from your insurance company?
This is bad advice and a good way to get the bills sent to a collection agency.
OP, call the doctor's office and find out whether they sent the bill to your insurance company. If not, ask them to call the insurance company and negotiate the fee. It is the insurance company that must cover you for out of network ER charges. If they already billed the insurance company and the ins denied the claim as out of network, call the ins company and tell them that they must cover the visit and should contact the doctor and negotiate the fee.
Have you gotten an Explanation of Benefits for that doctor from your insurance company?
Most people get an EOB (Explanation of Benefits) notice from their insurance company detailing what and how much was paid for whether "in" or "out of network" assuming they have decent insurance.
Most of the balance billing problems happen after this point, with the out-of-network doctor sending a bill for the difference between what he wanted and what the insurance company paid.
suzy_q2010 - You are absolutely right that in some cases, the out-of-network doctor will directly bill the patient, bypassing the insurance company entirely and the patient is required to do all of the legwork to make sure the out-of-network doctor gets paid.
Another variation occurs when the insurance company sends you a check for the amount they will pay the out-of-network doctor and you're supposed to send it on -along with a check for the balance.
To me this whole concept of "balance billing" is just a symptom of greed in the medical profession. That's why states are starting to outlaw its practice.
One good point to note, is that after a bill is sent to a collection agency, you're under no obligation to pay it! If the doctor or hospital sold your debt to a collection agency for 5 or 10 cents on the dollar, its an indication that their services were not worth the original price charged in the first place! Maybe their original bill should have been only 5-10% higher than what the insurance company paid!
Under no circumstances would I ignore this invoice. Even if you have no obligation under the law, if you ignore them the provider will eventually send to collections - which is a ding on your credit, not to mention the nuisance of dealing with bill collectors and getting your credit repaired.
Do as Suzy Q says. Contact the OON provider and then, if necessary, the insurance company. I would also send a followup letter to that provider stating that under the law passed on x date in your state, you are not responsible for ER services from an OON provider and OON provider is obligated to resolve this matter with your insurer and should never have billed you in the first place. Keep a copy of that letter.
I second Ariadne22's sentiment. Most emergency room doctors who work at an in-network hospital (relative to your insurance) are "out-of-network people" who work at, but not for, the hospital. Go over your bills with a fine tooth comb and contact all concerned parties. Knowledge is power and you might be able to come to a satisfactory resolution without digging into your wallet.
One good point to note, is that after a bill is sent to a collection agency, you're under no obligation to pay it! If the doctor or hospital sold your debt to a collection agency for 5 or 10 cents on the dollar, its an indication that their services were not worth the original price charged in the first place! Maybe their original bill should have been only 5-10% higher than what the insurance company paid!
Being sent to collections represents an effort to get even a small fraction of what the patient owes. The patient needs to decide whether refusing to pay his debt is worth the ding on his credit record.
This is bad advice and a good way to get the bills sent to a collection agency.
OP, call the doctor's office and find out whether they sent the bill to your insurance company. If not, ask them to call the insurance company and negotiate the fee. It is the insurance company that must cover you for out of network ER charges. If they already billed the insurance company and the ins denied the claim as out of network, call the ins company and tell them that they must cover the visit and should contact the doctor and negotiate the fee.
Have you gotten an Explanation of Benefits for that doctor from your insurance company?
Thank you for the advice everyone. Suzy_q2010: no, I have not received an EOB from the insurer. What I received was a bill from what I assume is the agency who is handling billing for that Dr. showing that they billed the insurer and the insurer responded with a code which means Pat Resp. For all I know they created this invoice themselves as I have no other proof the insurer actually received the bill or sent them anything.
I am going to go through all of my EOB's to ensure I don't have it, and my next step will be to call the insurance company as you suggested. I will then call the company sending me the invoice asking where I can send a letter stating the balanced billing laws and to contact the insurance company.
Try googling 'florida insurance commissioner'. I'm surprised it's a .com instead of a .gov, but it looks like the state's website.
Thank you!
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
