An Ohio man’s medical emergency last year turned into a financial nightmare when he received a medical bill for more than $17,000 for his plastic surgeon’s services.
Although he went to a hospital that was in his insurance network, the plastic surgeon who operated on him was not.
It’s become a familiar problem across the country as patients receive surprise medical bills for services they thought were covered by their insurance plans only to learn that the provider who cared for them was out of the insurer's network.
Reid Rupp, the Ohio man who received the $17,000 bill, has appealed the charges, the Dayton Daily News reported, but so far the insurance company, benefits broker, the surgeon’s office, Miami Valley Hospital where he received care, his state representative and the Ohio Attorney’s General Office have been unable to resolve it. The bill has since been sent to a debt collection agency. The surgeon would like to discuss the fees with Rupp but said the hospital has prohibited him from doing so, according to the article.
Physicians across the country are becoming more frustrated with surprise bills due to narrow networks. In many cases, hospitals use physician outsourcing firms for doctors that do not participate in the same network as the hospital. A coalition of physicians known as the Physicians for Fair Coverage proposes removing patients from insurer-doctor disputes, requiring transparent and predictable pricing between insurers and doctors and creating a minimum standard for reimbursement with penalties for insurers and doctors who don’t comply.
The group believes that there should be a fair standard for out-of-network services using a reimbursement schedule connected to an independently recognized and verified charge-based database. It recommends that FAIR Health, which it says maintains the largest collection of private insurance claims in the United States, be used to benchmark physician fees.
Patients need some sort of relief. A recent survey by Bankrate found that only 39% of Americans surveyed said they could cover a $1,000 emergency via savings. More than a third said they’d sink into debt, either paying for it with a credit card, borrowing from family or friends or taking out a personal loan. And a 2017 survey by the consumer financial planning site found that a quarter of Americans have chosen to forgo medical care because they can't afford the costs.