You Money or Your Life

[easysurfer]

Here's a situation in the news where the person had a heart attack and went into a coma. The ambulance took her to the nearest hospital which was not in her network. End result is about $40K of bills vs $1500.

"She did everything right," University of Wisconsin health care advocate Meg Gaines said. "There isn't anything else she could have done except don't have a heart attack maybe, but I think that's why we buy insurance."

There's no definitive data on how often patients are taken to hospitals not covered by insurance, but officials at St. Mary's said they believe Rothbauer's case is hardly isolated.

Wisconsin woman sent to out-of-network hospital faces whopping bill - CBS News

Actually, IMO, owing 40K out of 300K is not a bad deal. ... I bet with the media coverage that some folks will step in and help out. Just my hunch.

 

[nuke_diver]

Not wanting to be political or anything but I find it is sad where in the richest country in the world, getting sick can bankrupt you... but it is called insurance for a reason...

however it is your Lupins or your life I believe

 

[marko]

Doesn't going to the nearest hospital during an emergency override the in/out of network provision?
What if you were travelling?

 

[Walt34]

Doesn't going to the nearest hospital during an emergency override the in/out of network provision?
What if you were travelling?

That's what my BCBS policy says - under circumstances like that they'd cover it.

 

[M Paquette]

Doesn't going to the nearest hospital during an emergency override the in/out of network provision?
What if you were travelling?

Well, yes, for the hospital, provided that one complies with all the bits in the policy about notifying the insurer. Mine says I have to call an 800 number within 24 hours of admission, and obtain approval. As soon as I'm considered stabilized, I'm supposed to move to an in-network hospital.

Now, for the doctors, professional staff, pharmacy, and labs the hospital might use, that would be considered separately. If they are out of network, they won't be paid for, excepting emergency services paid at the in-network rate, usual and customary rate, or Medicare rate, whichever is greater. (Section 2719A of the PHS Act as amended by the PPACA)

Then... “[o]ut of network providers may, however, also balance bill patients for the difference between the providers’ charges and amount collected from the plan . . .” per Federal Register: June 28, 2010 (Volume 75, Number 123)][Rules and Regulations][Page 37187-37241].

TL ; DR ?

Even if the hospital accepts what the insurer offers, and you do everything right, you are on the hook for all the out of network doctors and lab work.

 

[easysurfer]

In the case of the article, I wonder too how [-]easy [/-]difficult it was to get any information if the doctors or lab folks are in or out of network during the hospital stay.

Billing usually is done after the fact to see what is in network vs out of network.