What You Can Do if You Have a Surprise Medical Bill

Understanding medical bills can be confusing, especially when you are trying to figure out what is and isn’t covered by an insurance company. For some, their medical bill is thousands of dollars more than expected. NBC 6 Responds spoke with a woman who ended up with a $343,000 medical bill.

“I mean that’s a large balance, I mean we looked our dream is to buy a home and how can you buy a home if you have a balance like that and grow as a family,” Jennifer Talavera said.

NBC 6 Responds helped get Jennifer Talavera’s bills a second look. She was told to pay out-of-pocket for the care of her twins during their time in the neonatal intensive care unit.

“Complete anxiety, stress. How am I gonna’ handle this? You know, thinking about my children, putting them through school, how can I afford to do that?” Talavera said about the stressful situation.

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After NBC 6 Responds got involved, we found her children’s insurance coverage wasn’t the same in part because one doctor was considered in-network and the other was listed as out-of-network.

“But I never would’ve chosen an out-of-network doctor for one child and an in-network doctor for the other. So, I don’t even understand how that could’ve even happened,” Talavera said.

It’s money her insurance company has now told her she doesn’t owe.

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“The greatest thanks of all to NBC 6 for listening to my story and helping me with this battle,” Talavera said.

There are steps you can take if you find yourself in a dispute over medical charges.

“When you have health insurance, what you basically have is a contract between you and your health insurance company,” attorney Patrick Sullivan said.

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Sullivan says it’s important to know what’s considered in-network and out-of-network in your health insurance contract.

“Nobody wants to hear that you have to do some work, but you have to look over your insurance policy, see what’s covered, see what your deductible is, see if there’s co-insurance that you’re going to have to pay and that’s before the insurance even pays some of your bills,” Sullivan explained.

In some cases, avoiding an out-of-network medical charge isn’t easy.

“You don’t get to choose who you see when you go to the emergency room, so the doctor in the ER is out of network, but you don’t have time to ask and you don’t have a choice on who you see,” Sullivan said.

He says in emergency room situations you may be asked to sign a form called an “assignment of benefits.”

“There’s fine print that nobody’s going to read, especially in an emergency situation. That’s giving all the rights to all the providers to collect under that contract,” Sullivan said.

If you are seen by an out-of-network physician, the provider has the right to seek payment from your insurance company and potentially you too. If you receive a surprise bill, he says often you can negotiate a bill down with the provider or you can file an appeal with your insurance provider.

There are laws to help cut down on surprise billing. This year, it became a federal requirement for hospitals to list prices for procedures and supplies online. In 2016, A Florida law went into effect that limits unanticipated or balance billing in certain cases.

If you need help understanding your rights, Sullivan suggests reaching out to a medical advocate or an attorney.

“And just sitting down with an attorney for 15 minutes can make a huge difference in letting you know your rights and letting you know your options because all of this is extremely complicated,” Sullivan said.

If you cannot afford to pay a bill reaching out to the hospital or billing entity could be helpful.

Some hospitals have financial assistance services that can help if you cannot afford to pay.