When a person receives the news from their physician that they will require surgery or have been diagnosed with some sort of serious condition, they will more than likely experience a wide range of strong emotions.
However, once these feelings subside, they will more than likely get down to business, selecting a hospital/provider and, of course, investigating their insurance coverage in order to ensure that the costs associated with the treatment remain manageable.
However, what happens when there is a medical emergency, or a person picks a hospital in their network only to have the procedure performed by a physician who, unbeknownst to them, is not in-network?
By way of illustration, consider the experience of a Boca Raton woman who was diagnosed with a brain tumor and had the necessary surgery performed at an in-network hospital.
In addition to being presented with a new lease on life, she was also presented with a massive bill because, due to circumstances entirely outside of her control, the brain surgeon who performed the procedure was not in her network and charged $85,000.
Indeed, her insurance company only agreed to cover $3,110, leaving her with $81,890 in medical debt that she covered only by cashing in an IRA.
As unjust as this surprise billing — or “balance billing” — is, reports say it is happening much more often than people imagine, particularly in scenarios like the one outlined above or in medical emergencies. Indeed, a recent report by one health insurance advocacy group found that Florida ranks among the top five states for surprise charges relating to medical emergencies.
While the Sunshine State does have some rules in place to protect HMO patients from balance billing, it is nevertheless lacking any sort of widespread patient protection.
In fact, lobbying efforts are now underway by consumer advocates to spur state lawmakers to once again look at ways to curb the practice of surprise billing after last year’s failed attempt.
While we can only hope that some sort of solution can be reached by the state legislature, those faced with overwhelming medical debt should know that they have viable options for eliminating this burden and securing a fresh start.