BIRMINGHAM, Ala. (WBRC) -Many people struggle to pay their medical bills, as the cost of healthcare seems to steadily increase each year. We’re taking a look at something you may want to be aware of next time you go for a check up...surprise medical bills.
"I was having chest pains, shortness of breath. I really thought I was having a heart attack,” Sally Matchett said.
Last year Matchett got an $1,100 medical bill after she went to the emergency room for problems with her gallbladder. What she later learned is that while her trip was covered by her insurance, the doctor who saw her was out of network.
"It’s not fair how it went down. It was almost sneaky. No I was not notified,” Matchett said.
It’s called balance billing; otherwise known as a surprise medical bill. It happens quite often according to Shirley Rooker who is president of Call for Action, a non-profit that deals with thousands of consumer complaints each year. WBRC has been partnering with CFA for almost a decade.
"That can be a very hefty bill and can be a terrible surprise to consumers because they think they’ve done all their homework,” Rooker said.
The American Hospital Association recommends you ask questions before getting a procedure done. If you need care, ask where it will take place and ask who else might be involved, just to make sure they are in your network.
"You may be unconscious and an anesthesiologist may be there working with you. Someone else may come in and be a participant and that person may not be a part of your program…and there you are stuck with a bill and your insurance provider is probably going to say nope..we’re not going to pay for it,” Rooker said.
A December 2018 Commonwealth Fund survey found only 25 states have laws offering some form of protection against balance billing. Alabama is not one of them.
"It’s almost impossible to know who’s going to help you in a hospital especially in you go in for an emergency situation. The more research you can do initially when you’re getting an insurance plan the better off you’ll be,” Rooker said.
As for Sally’s high bill, it took some work, but she was able to cut it down to just a few hundred dollars. She just wishes her insurance company and healthcare industry were more upfront about it.
We asked Blue Cross and Blue Shield of Alabama how it deals with balance billing issues.
“For in-network providers, we pay the claim according to our member’s in-network benefits, and the provider is not allowed to balance bill our member for the remaining charge. For out-of-network providers, we pay the claim according to the in-network provider rate and the member’s out-of-network benefits, and the provider can bill our member for the remaining provider charge if they choose to do so.” Koko Mackin, Vice President of Corporate Communications for Blue Cross and Blue Shield of Alabama said.
The Blue Cross Blue and Shield Association is calling on a federal ban of balance billing. The healthcare group wants to protect patients from these unexpected bills particularly in situations where patients can’t control who provides the care.
You can read more at Blue Cross Blue Shield’s website.