How to address surprise medical bills

Consumers with surprise medical bills are unaware of their rights and that they should complain to their state regulators.

How to address surprise medical bills

You have health insurance and think a service you receive will paid partly by your plan coverage. If your insurer paid less than you expected for the medical bill, you are surprised and wonder what to do. This article will explain some of your rights and where to complain.

During the past two years, 30 percent of privately insured Americans received surprise medical bills, according to a recent Consumers Union survey in May 2015. These bills were for more than what the consumer expected to pay.

The key question revolves around in-network verses out-of-network (OON) providers. Most insurance plans have a contract with certain hospitals, doctors and related medical services that are part of their network. To be really confusing, sometimes an out-of-network doctor practices at an in-network hospital.

Possible solutions depend on three common problems. Policy makers are still working on these issues. However, you may be able to identify those that match your situation to decide on the best action(s).

  • Inaccurate provider directories mislead patients into choosing a provider that is not in-network. Solution: Ask insurer to hold you harmless for OON bills based on inaccurate provider directories.
  • Non-disclosure of out-of-network providers. Solution: Providers must make pre-service disclosure of estimated patient costs at least 72 hours before service to allow patients to make other plans or arrange for in-network providers.
  • Excessive charges by specialists and other providers that provide care outside of insurance networks. Solution: Include consumer assistance and regulator contact information at the bottom of Explanation of Benefits (EOB’s) to fully insured enrollees. This would enable more consumer awareness of where to inquire about their rights, register complaints and receive help. In Michigan, contact the Department of Insurance and Financial Services (DIFS) hotline at 517-284-8800 or 877-999-6442 (Toll-Free).

Michigan State University Extension provides education about health insurance basics, including the why, what and how for making a smart decision. Find out about Smart Choice: Health Insurance and find factual information online.

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