Who has time in an emergency to check if a doctor is in or out-of-network? If you don’t, you could be on the hook for thousands of dollars just because the doctors and your insurance company can’t come to an agreement.
Julie Drake of Tacoma went to an emergency room for a kidney stone attack. She was told the hospital was in-network but she still got hit with a $700 bill.
“It showed that the doctors were not covered,” explained Drake.
The issue was the doctor who was out-of-network. But how was she or anyone else going to know that in an emergency? This kind of surprise billing for emergency healthcare is happening all over state. To better inform consumers Insurance Commissioner Mike Kreidler brought House Bill 2447 to the legislature.
“A lot of times the hospital won’t know who’s in network and out-of-network. But i think they have an obligation to make sure that if there’s an opportunity to make a decision here they are informing you as the patient,” said Kreidler.
Some doctors have contracts to work in hospital emergency rooms but they don’t have a deal with a specific insurance company. As Mel Sorenson with America’s Health Insurance Plan explained, that means patients may have to pay out of pocket for care.
“The problem exists where providers decline to sign a participating provider contract,” said Sorenson. “Leaving these covered individuals in a circumstance of accessing services from a provider group that has not contracted.”
The bill would force mandatory arbitration between insurers and doctors. In a recent hearing both sides say they aren’t interested in that at all.
“If you take balance billing out of the equation, then you take out any incentive for insurance companies to come negotiate a fair contract with us,” said Erik Penner of Olympia Emergency Services.
Meanwhile, patients like Drake don’t understand why there’s not more interest in helping patients like her.
“A lot is being done to address people who don’t have health insurance but we still need to address the fact people with coverage are not receiving what they think they are paying for,” said Drake.
Washington’s proposed bill based on a current Illinois law.
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