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A Kaiser Health Tracking poll recently revealed that, of adults ages 18-64 with health insurance, 40 percent have received an unexpected medical bill in the past year—ten percent of these consisted of a surprise bill from an out-of-network provider. These surprise bills, or balance bills, can cost tens of thousands of dollars or more, threatening an individual’s financial stability and leaving them with cripplingly high debt. These bills often come even after someone made a conscious effort to pick a hospital that is in-network with their health insurance plan.

How does this occur on such a frequent basis? Usually it’s because patients will go to an in-network hospital or a hospital that has established set prices for different services with their insurance company. The patient believes they are fully covered, but not all medical professionals working in the hospital are necessarily considered official staff members. Sometimes individual doctors do not have an agreement with the insurance company, so they bill the patient later for the out-of-network medical services they administered. Many of these patients are completely unaware that the doctor or medical professional that treated them was out of network; they naturally assume that their services will be covered because the hospital is in-network and are rarely if ever informed otherwise before receiving care.

Recently, a 44-year old Texas teacher, Drew Calver, was charged $109,000 after receiving medical care for a heart attack .His insurance carrier only paid $56,000 because of out-of-network surprises. Luckily, this story got picked up by the news and the public outcry led to the hospital reducing Calver’s responsibility to $332. Unfortunately, most individuals with surprise bills do not have such a high level of public support.

In Tennessee, out-of-pocket medical costs rose abruptly in 2018 due to a drawn out negotiation process between BlueCross BlueShield of Tennessee, the largest insurance company in the state, and Anesthesia Medical Group (AMG), the largest anesthesiologist company in the state. The two companies have since struck a compromise, but if they hadn’t BlueCross members would have been forced to pay hundreds or thousands of dollars more to continue receiving anesthesia care at multiple facilities.

To better understand what your medical bills are holding you accountable for, you might want to read this blog on What Your Medical Bills Mean (in plain English). Unfortunately, thousands of patients suffer financial hardships each year due to confusing hospital billing and surprise charges that catch them off guard.

Additionally, you might want to contact a knowledgeable attorney. The personal injury lawyers at Bailey & Greer, PLLC, work with your doctors to understand and document your injuries. If you or a loved one has been a victim of unexpected medical bills, call us today at 901-475-7434 or fill out our contact form to make an appointment with our experienced team.

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