We owe what?

Greetings faithful readers.

Today NPT brings you a discussion of a topic that has become a recent thorn in my side - balance billing.

For those of you unfamiliar with the term, it goes like this... You visit a doctor outside of your insurance plan's "approved providers". The doctor takes whatever payment the insurance company provides and then bills you for the difference. Seems fair and simple except for....

Let's say you have a medical emergency and visit the local hospital (part of your insurance plan) for treatment. You are seen by an ER doc who sends you for x-rays which show you need emergency surgery. The surgery is performed and after it is done you need to recover for a couple of days in ICU.

After discharge, you thank god for your insurance because the only cost you have to pay is for the deductable.

Whoa, not so fast there Bud.

A few weeks later you get bills from the ER docs (not part of your plan), the radiologist who read the x-rays (not part of your plan), the surgeon (not part of your plan), the anesthesiologist (not part of your plan), and the ICU physicians (not part of your plan). They have all gotten their payments from the insurance company for "out of network" benefits and are looking to you for the balance.

So much for an "in-network" hospital if none of the doctors you actually see there are "in-network".

So, in our case everything from Zach's surgery was covered by insurance except for the attending physicians in the ICU unit, who are not part of our "network". There is a battle brewing between us, United Healthcare, and this physicians group.

There are so many nuances in this whole issue to get into, and I'm going to need to break this down into several posts - so stay tuned.