Millions of patients are paying medical bills they don’t actually
owe after being confused about the practices of "balanced billing," according to a recent Business Week report.
The story goes onto discuss how it’s illegal for doctors, hospitals or labs to bill patients for the difference if they deem the insurance payment too low, but that it happens routinely to the tune of $1 billion each year.
Around the time that story first ran, THCB received this email from distraught reader, Paul Evans of Arizona:
I recently went into an emergency room at a local hospital in Scottsdale, Ariz. The doctor asked several questions and diagnosed kidney stones. To confirm this, he ordered a Cat scan and X-rays. While there I was given morphine for the pain. Two hours later, I was discharge with a prescription for pain pills and a strainer to examine my urine for the stone I would pass. I am insured by Aetna. Aetna received a bill for $6,000 and paid $4,000. I am now receiving bills for the remaining $2,000. All this for two hours in the emergency. Do I have to pay these bills? This is balance billing I think. What are my rights? Help!!
This isn’t balanced billing. Paul’s health plan required him to pay a share of cost and he was unaware of how much. This lack of understanding traps consumers in balanced billing practices.
Paul’s lack of understanding of his health benefits is far from an isolated case. As Jane Sarasohn-Kahn wrote here a few months back, one survey found that only half of the respondents reported understanding their benefits.
The health care system remains a mystery to most people even the
well-employed and highly educated. Many insured people don’t know the
details of their health plans until it comes time to use it — often in
I e-mailed Paul back to see if he knew he had a share of cost, and how great of a burden the $2,000 bill is for him. Here’s what he wrote:
You are correct I was unaware that I would have to pay such charges. I have the savings to pay, but so many others do not. Also my concern is that when you are in pain, you don’t discuss treatment and costs with the doctor. Was a Cat scan really necessary? X-rays? I think that the hospital takes advantage of pain and ignorance to run up the bill. As I say, I can pay these charges, but what about others who can’t?
Just as Paul’s shock at his high ER bill isn’t unique, neither is his combined mistrust of the hospital, doctor or health plans’ motives.