Surprise medical billing and how it can affect Arkansas residents
LITTLE ROCK (KATV) — It’s called surprise medical billing and as the name suggests, it happens when Americans are caught off guard by a medical bill.
Imagine being airlifted by helicopter or taken to the emergency room in an ambulance. Realistically, patients are probably not requesting to be taken to a hospital in their insurance network during an emergency. The priority is getting help as quickly as possible.
A doctor or a hospital could be in-network, but another surgeon in the room might not be. That's where the surprise comes in.
It's a financial nightmare no one wants to be in, but during a medical emergency, it can happen. In fact, more than half of Americans have been surprised by medical bills, according to a 2018 national survey cited by the Arkansas Center For Health Improvement.
“Surprise billing is when you go to an in-network provider for what you believe is going to be a covered service and for some reason part of that service comes back with a very high bill that is declared out of network or not a covered benefit,” said Dr. Joe Thompson, the center’s executive director.
Thompson said that surprise medical billing can cost tens of thousands of dollars.
“You go to the emergency room and you're treated at a hospital that is in your network, but you need a sub-specialist to come in because you have an ear, nose and throat problem or a gastroenterology problem,” he said. “And that specialist is not in your network. Then the specialist charge is out of network and much higher."
During an emergency, a patient will likely be brought to the closest facility or specialty hospital and be left with no choice for in or out of network care. It's also likely a patient doesn't have a choice even during a scheduled procedure.
"We have what's called an any-willing provider," Thompson said. "Most of our providers are in most of the networks so it's not as often that somebody gets caught in the loophole. But this is a major issue in other states, and we need to be careful and watch closely for its emergence here."
As part of legislation passed in 2015, the Arkansas Center For Health Improvement developed a healthcare database allowing it to track costs and help consumers make informed decisions.
Thompson told Seven On Your Side it's also an opportunity for the center to provide data to lawmakers if legislation is needed.
If you have been surprised by a high medical bill, contact Seven On Your Side at (501) 324-4357 or SOS@katv.com.
