Consumer Reports: Avoiding surprise medical bills

PHILADELPHIA (WPVI) -- A potentially lifesaving trip to the emergency room could result in exorbitant and unexpected bills - even if you have insurance. Consumer Reports explains why you can be socked with surprise ER bills, and how to protect yourself.

John Elfrank-Dana had to have two emergency brain surgeries after he hit his head and suffered a brain bleed.

He thought his medical insurance would cover the costs. Instead, he was hit with more than $90,000 dollars worth of bills.

"I was shell-shocked," he said.

What John didn't know is that about two-thirds of emergency room doctors are independent contractors who may not be covered by your plan.

Doctors can bill you for what your insurance doesn't cover.

"Do your research before an emergency happens. Contact your area hospitals and ask if they take your insurance. Then ask your hospital of choice whether the ER doctors there will take your insurance, too," said Donna Rosato, Money Editor for Consumer Reports.

Ambulances, lab services, and special equipment can also fall into the out-of-network category - potentially costing patients thousands of dollars.

Consumer Reports says if you get out-of-network bills, don't pay anything until you get an EOB - an explanation of benefits - from your insurer. Compare that with the bills. And confirm with your insurer that the providers are not in your plan.

"Then ask your provider if they'll settle for what the insurance company has already paid. Be persistent. You'll be surprised; some doctors will negotiate with you," suggests Donna.

You can also appeal to the agency in your state that regulates insurance carriers - like John did. It has taken him a year, but John has finally seen a reduction in his bills.

"You have to do your research. You have to really be a smart consumer," he said.

Several states have laws to prevent people from being charged out-of-network fees for hospital doctors in emergency or other situations. The Pennsylvania legislature is considering a bill to address the issue.

Pennsylvania Insurance Commissioner Teresa Miller offered testimony this week to the Pennsylvania State Senate Banking and Insurance Committee on the issue of surprise balance billing and steps her department has taken to address the problem. The hearing was held Wednesday morning on Senate Bill 1158 (SB 1158), sponsored by Senator Judy Schwank (D-Berks), which provides a proposed solution to surprise balance billing.

To read more about the hearing, CLICK HERE.

For info on how to reach the insurance department in your state and when available a nonprofit that will help with your insurance problems, CLICK HERE. You can get additional guidance from the Patient Advocate Foundation at 800-532-5274.

To read the full report from Consumer Reports, CLICK HERE.