Lorena Martin’s 18-year-old son, Robert, hurt his ankle playing football one recent Friday evening. He was in pain and unable to walk, and she was concerned that he’d done real damage..
Both her doctor’s office and the nearby urgent care center were closed, so with no other options, she took him to the emergency room.
The hospital was in her health plan’s network — she’d made sure of that. Once there, Martin paid a $50 co-pay and later received a bill for an additional $270, which she expected.
“That was the percentage of our responsibility” for the visit, said the 46-year-old school secretary from Westchester. “I’m cool with it.”
But she was in for a surprise. Several weeks later she got a bill for about $1,400 from the doctor who saw her son in the emergency room for less than 10 minutes.
“I called my insurance company and they gave me the song and dance about how this physician was a nonparticipating provider,” she said. “I said, ‘I went to your participating hospital. How does this make sense?'”
But she was told that the charge was legitimate and that she was on the hook for the bill.
Like Martin, millions of Americans get surprise bills from doctors who don’t participate with their health plan but who practice in hospitals that do.
With no contract in place to dictate how much doctors get paid for services, they can bill patients for charges beyond what insurance covers.