Subject: Treatment at the Emergency Room
Attached above is a an article written by one of our Retiree health trustees.
Problems after visiting a hospital ER for treatment.
FELLOW AND FUTURE MEMBERS
This article will discuss the tremendous financial burden people suffer when they go to the hospital for emergency treatment.
When a person receives care at an in-network hospital, he generally assumes that the attending physicians and specialists are also in-network. They are mightily surprised when they receive a bill from the attending providers that are not in net-work.
Many physicians working in hospital’s E.R’s are contract workers that are not directly employed by hospitals. Many of these contract physicians that provide care in hospital’s E.R’s might not be in net-work.
Knowing whether a doctor in or out of net-work is generally not known until weeks later when a bill is delivered to the patient. The bill is the difference between what the insurance paid and the out-of-network costs. The bill balance is now the responsibility of the patient. The amounts can vary from a few hundred to thousands of dollars.
This very unfair method of billing blindsides patients that are most vulnerable. This unfair practice of billing is disproportionately tied to emergency room care.
State representatives should have the courage to confront and fix this problem as other states have done. It is suggested that if patients go to in-network hospitals they should receive in-network billing. The medical provider and the insurers should settle out the difference.
Florida, New York and California have tackled the problem by requiring in-network billing when patients go to in-network hospitals and other facilities. Two Texas Lawmakers, state Representatives John Smithee, R-Amarillo, and state Senator Larry Taylor, R-Friendswood have said that they would consider such legislation.
Unfortunately the Fire and Police Health Fund cannot intercede for our members when they are hit with not in-network billing. Furthermore, the Fund cannot determine whether a physician is or is not in-network in an emergency situation. It is the responsibility of the member to determine whether the doctor is or is not in-network.
If emergency care is necessary, a relative or a friend can call the Health Fund and pre-certify the patient. If this happens on a week end the patient has 48 hours in which to pre-certify. However, it is the responsibility of the patient to ask and determine if the doctor is in-network.
What can you do if this happens to you? Go to the hospital or to the doctor and bargain the extra billing down. They may or may not agree, but argue the point of the unfairness of the extra billing. I suggest that when arguing this point that you remain calm and composed while presenting your case. Sometimes more often than not, offering a fully paid discounted amount will be accepted.