Despite millions more Americans having insurance under the Affordable Care Act (ACA), many still get hit with surprise bills from their carriers, prompting some states to study the phenomenon more closely and respond with legislation.
Such bills come as a result of patients who unwittingly seek care outside of approved networks, the Wall Street Journal reported. Out-of-network charges are not capped under the ACA as are other costs, leaving many unsuspecting health plan enrollees getting hit with tremendous bills.
As the Wall Street Journal reported, it's easy for patients to fall out of network in terms of the care they receive, because contractual arrangements change constantly. Or, they may be referred to an in-network hospital by a physician who is not within the network. The state of affairs is different than in the past, when patients may have been facing out-of-network charges due to contract disputes.
One such health plan enrollee, Arturo Paramo, received a bill for nearly $23,000 after he was admitted to a Tennessee hospital that was out of network. His doctor had sent him there following an electrocardiogram. The hospital eventually cut its charges to $600, but only after the bill was sent to a collections agency.
In California, legislation was recently passed by the Assembly that would exempt patients from out-of-network charges if the care is provided at an in-network hospital. However, the Los Angeles Times has reported that the California Medical Association is opposed to the bill, which has yet to be approved by the state Senate. Bills in New Jersey and Connecticut have run up against opposition as well.