Hospital Insurance Gaps Could Make You Sick

You know those extra charges that hotels sneak into your bills, like resort fees, convenience fees, service fees and the like? Well hospitals and their doctors frequently inflict worse ills upon their insured patients. And you could be left holding the bag, and I’d rather not specify what kind of bag I’m referring to.

The problem is worst in emergency situations. Let’s dissect how this happens. If your in-network doctor brings in a specialist, consultant, or other hospital employee who is not part of your insurance network, your insurer may cover only a portion of that person’s fees, or none at all. And when you’re on a gurney in an ER it could be a bit difficult to question their insurance credentials of the gal who just shoved that thermometer into your mouth.

If you are on Medicare, you’re protected against excess fees. But if you have private insurance there are steps to take to protect yourself:

  • Know where to go in an emergency. Make sure the hospital is in your network and inquire as what percentage of ER doctors and medical personnel are in your network. If the percentage is low, look for another facility.
  • If you are to undergo a scheduled procedure, ask your doctor who else will be involved in your procedure and demand in-network providers unless there is an exceptional necessity for an out-of-network specialist.
  • If an out-of-network specialist is required, talk to your insurer well in advance to see if it will cover your costs. If it rejects your request, try to talk with a person higher up the chain of command.
  • If that doesn’t work, wait until you receive a rejection and then file an appeal.
  • If all else fails, you may try asking your state insurance department or attorney general’s office to intercede.

A bit of careful preparation could save you thousands of dollars and ton of grief.

Source: Interview with Elizabeth Ryden Benjamin of Community Service Society, in Bottom Line Personal, November 15, 2014.