Miami Herald Examines Out-of-Network Charges For Care At In-Network Hospitals

Main Category: Health Insurance / Medical Insurance
Also Included In: Public Health;  Primary Care / General Practice
Article Date: 28 Jan 2009 - 3:00 PDT

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The Miami Herald on Sunday examined a "central problem" with the U.S. health care system: patients being surprised by secondary bills because the facility at which they received care was in their coverage's network but the physician who treated them was not. According to the Herald, insurers will pay a minimum amount for using an out-of-network provider but the provider will seek the remaining balance from the patient.

The Herald reports that the "problem ... keeps getting worse as employers and insurers squeeze consumers to pay more through deductibles and penalties for going out of network." According to the Herald, out-of-network penalties may be difficult for patients seeking urgent or emergency care to avoid because federal law prohibits any discussion of situations that might discourage a patient from receiving treatment, which is "a provision that providers sometimes use to explain why they don't talk about network or price issues."

Gail Shearer of Consumers Union said, "This points to the loopholes, the sucker punches that people get navigating our health care system." In some cases patients have had their bills adjusted after contacting their insurer or the in-network facility and making a complaint regarding the bill (Dorschner, Miami Herald, 1/25).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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