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Wilmington, North Carolina

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Jean Martin
Jean Martin
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Why Do I Have All Of These Out-of-Network Charges For Care At An In-Network Hospital

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As you and your family prepare for surgery, choosing the right doctor, might end up a choice costing you more than you budgeted for. Those with health insurance normally pick doctors that are “in network” which allows them to be covered under their insurance plan. However, when the bills start arriving, these patients notice charges from “out of network” doctors, some of which the patients never meet such as anesthesiologists or radiologists. An out of network charge is common in HMO and PPO insurance plans.

The “out of network” charge, is considered a major problem with the current system of health care in the United States. Patients are receiving these bills without any prior information that they will be hit with these charges. These charges have no end in site either, as more out of network payments are cropping up in patient’s hospital bills as the increasing cost of health care is causing insurance programs to shrink coverage, increase deductibles and force less coverage for out of network physicians.

Reports are also being released that insurers are not paying their fair share of the bills that are being received by patients for out of network doctors. The Attorney General of New York, Andrew Cuomo, after almost a year long health care investigation, reached an agreement with one of the nation’s largest health insurers to reform their out of network billing practices.

Most Americans are choosing health care plans that allow for out of network providers, however the insurers are paying less than the total cost for these providers as they us a “usual and customary” rate, however most of these specialist doctors do not charge the normal and accepted rates, instead are much higher that “usual” physicians.

If you have been the victim of out of network billing that you were not expected, fight back and ask for answers. Don’t just accept the charges. And if you don’t get answers, seek legal representation to check if you are entitled to compensation and remedies for your extra payment. Many Americans are struggling with these payments and you are not alone in this battle.