Some people in California may be among the 1 in 7 nationwide who are surprised by medical bills from out-of-network providers despite visiting an in-network hospital. The incidence varies from state to state, with admissions that include at least one out-of-network claim below 2 percent in Michigan but higher than 26 percent in Florida.
At issue is the medical billing system and the lack of transparency for consumers. Patients have no way of knowing whether an independent lab or particular physician at an in-network hospital is also in-network, and even asking does not always provide reliable answers. The incidence is particularly high with independent labs and anesthesiologists. Among the other specialties with the highest rates of out-of-network claims within an in-network system are primary care, emergency medicine and radiology. Insurance policies and their requirements are growing increasingly complex, but it is not just patients who are paying the price. The cost of adjudicating claims annually is also high for hospitals and insurers.
Various solutions have been proposed by legislators. These include a cap on charges from out-of-network or using arbitration with insurers and providers who are engaged in disputes over out-of network charges. However, no timetable is in place for the introduction of these laws. Meanwhile, both hospital and insurance executives have expressed a desire to resolve the issue.
Issues such as this one contribute to the rising amount of medical debt, and many people who file for bankruptcy because of these types of expenses have health insurance. People who are struggling with medical debt may want to contact an attorney to discuss their options. While some people hesitate to file for bankruptcy because of the effect it will have on their credit score, falling behind on payments also affects credit.