Your emergency room bill has a loophole that most people don’t know about—and a solution they don’t know about, either
I had a health scare with tingling down my arm, so I went to the ER. I have insurance and went to an ER that’s in our network—but I got a bill from the doctor who’s apparently not in my network. Is that even legal?
How am I supposed to know to ask a doctor if they’re in my network while I’m freaking out that I’m having a heart attack? Is there anything I can do now? Or am I just stuck with this bill that I can’t pay?
—Michael in Tennessee
Howard Dvorkin CPA answers…
You can ask to pay less. That sounds like weak advice, but you would be surprised how often that works—especially with an emergency room bill.
We’ll discuss the details of that approach in a moment. First, let’s explain the infuriating details that trapped you in this expensive situation.
How surprise ER bills happen
Anyone who’s purchased health insurance already knows the terms “in network” and “out of network.” To keep health costs under control, insurers contract with certain doctors in your area. You must choose from their list or pay a penalty for going “out of network.”
There are exceptions to this practice, and one of those is emergency rooms. For obvious reasons, emergencies need to be treated right away. So federal law actually makes it illegal to charge you extra for visiting an out-of-network ER.
(Even here, there are exceptions for what the government calls grandfathered health insurance plans purchased before 2010 and not updated. But this topic is complicated enough, so let’s just forget I mentioned it.)
Emergency rooms seem like the simplest part of a hospital: You go to one place when something bad happens, and they treat you as soon as possible. However, ERs are actually complex organisms. While your ER doctor might work at the hospital, specialists often don’t. For instance, if you need surgery, the anesthesiologist might be called in from somewhere else. Ditto with the radiologist. If they’re out of your network, you get stuck with the bill.
While I can’t know for sure, I’m guessing the heart specialist wasn’t in your network. This is quite common. One study found, “The proportion of emergency room visits to in-network hospitals that result in out-of-network bills surged from 32.3 percent to 42.8 percent from 2010 to 2016.”
The result: An average increase of up to $628 in out-of-network fees. Remember, that’s just the average from half a decade ago. It’s certainly more now.
What you can do now that you have an emergency room bill
If this happens to you, the first thing to do is…nothing.
It goes against my nature as a CPA and a debt specialist to say this, but your first course of action is inaction. Don’t pay the bill right away. You need to approach this strategically, and that will take a few days. Don’t worry, your credit score won’t be affected. In 2018, another government regulation ordered credit agencies to wait 180 days to report medical debt – and that clock only starts once the medical bill goes to a debt collector. So, you have time and you should use it to your advantage.
Your next step is to check with your state regulations. Currently, 15 states have laws that address this topic. I live in one of those: Florida exempts its residents from paying certain out-of-network fees. The best place to start is with Consumer Reports, which offers a free online tool to figure out the rules where you live, then tells you how to file a complaint.
Now we get to the tactic I mentioned at the beginning. You need to make two phone calls. The first is to the provider who mailed you the bill. Expect to go through an annoying phone tree, and once you get a real human being, ask to speak to someone in billing. Then describe your situation as calmly and as politely as possible.
There’s no guarantee, but sometimes these providers will reduce the charges to what you’d pay in network. The reason is simple: If you live in a protected state, they got to. And if you live in an unprotected state, they don’t want complaints to compel legislators to pass new laws.
Finally, call your insurer. Sometimes, it’s all just an honest mistake. One report says 80 percent of medical bills contain at least one error. It’s possible your outrageous charge is one of them.
Get a free evaluation to see if debt settlement can help with unpaid medical bills.
Published by Debt.com, LLC