Decoding Surprise Medical Bills: Understanding Network and Non-Network Hospital Charges

Navigating the complexities of health insurance can be daunting, and surprise medical bills often add unnecessary stress. In this blog, we explore a common scenario that can lead to unexpected expenses: receiving bills for non-network hospital charges.

Non-Network Hospital Charges and Their Impact

When you seek medical care, it’s essential to check if the provider is part of your insurance network. Non-network providers are not contracted with your insurer, meaning they can charge higher rates and you may be responsible for a larger portion of the cost.

In the case presented in the post, the health insurer initially coded the hospital stay as non-network, resulting in a hefty bill that went unpaid and ended up in collections. This is a common occurrence, as determining network coverage can be complex and confusing.

How to Handle Incorrect Billing

If you receive a bill for non-network charges that you believe are incorrect, it’s crucial to act promptly. Here are the steps you should take:

Contact the Hospital Billing Department:

Explain the situation and request that they review the billing code. They may be able to correct the mistake internally and adjust the bill.

Contact Your Insurance Company:

Inform them about the billing error and provide evidence of the hospital’s mistake. Your insurer may intervene and assist in resolving the issue.

Seek Legal Assistance if Necessary:

If the hospital and insurance company fail to resolve the situation, you may consider seeking legal advice to protect your rights.

Protections Under the Affordable Care Act (ACA)

Thankfully, the ACA provides some protections against surprise medical bills:

Balance Billing Prohibition:

In most cases, balance billing is prohibited, meaning network providers cannot charge you more than the in-network amount, even if you unknowingly receive care from a non-network provider.

Transparency in Billing:

Hospitals and insurers are required to provide clear and accessible information about costs, including estimates and explanations of any out-of-network charges.

Preventing Surprise Medical Bills

To avoid the hassle of surprise medical bills, consider the following preventive measures:

Choose In-Network Providers:

Whenever possible, schedule appointments with providers who are part of your insurance network.

Verify Coverage Before Receiving Care:

Before undergoing any major medical procedures or treatments, call your insurance company to confirm coverage and inquire about any potential out-of-network charges.

Keep Records and Track Bills:

Maintain a record of all medical appointments, bills, and correspondence with providers and insurers. This will help you identify and dispute any errors or overcharges.

Conclusion

Understanding the difference between network and non-network hospital charges is essential to avoid costly surprises. If you receive an incorrect bill for non-network charges, don’t hesitate to contact the hospital, your insurance company, and seek professional assistance if needed. By taking these steps, you can protect your financial well-being and ensure that you receive the fair and affordable healthcare you deserve.