You have insurance and you think you are insured against outrageous bills for medical treatment
Not always so, discovered Austin teacher Drew Calver, who raced to St. David’s Medical Center when suffering from a heart attack, and received a bill a month later for $109,000. When his story got media attention, the facility qualified Calver for a financial assistance discount and lowered his bill to under $800.
The Texas Medical Association responds:
"Insurance companies need to sell health plans that do not have tiny, narrow networks with too few hospitals, physicians and labs from which to choose. When that happens, the patient has to pay more of his or her medical bills, while the insurance company pays less. We understand that is what happened with this Austin gentleman, and it happens to too many people. By the way, last legislative session TMA pushed for expanded mediation in surprise-bill situations similar to his, to help patients. Thankfully, it passed into law. Everyone needs to learn and understand their health insurance coverage to protect themselves, and seek medical care in-network whenever possible."
They have a website page to address the issue, detailing the legislation they’ve been able to get passed in the state legislature.
Andy Adams of Adams Insurance concurs that knowing which facilities are included in your network are critical. “If you go out of your network then you could be subject to more out of pocket expenses, and a lot of plans have higher out of network deductions, and some plans don’t have any out of network coverage at all.”
He says if you don’t agree with a bill from a provider, negotiate. “I think the first thing you have to do is call the provider and complain, and put whatever pressure you can on it.”
Consumer Reports offers this advice on negotiating to lower a medical bill.