wanna bet she is a full blown dem and supported obamacare....
The Dallas Fire Department EMTs are out of network for Blue Cross. Call 911 and get sticker shock.
She should be happy to hand over the $56k. After all that is what funds the illegals and other derilicts hospitals are forced to treat who pay nothing.
She should tell the hospital and its doctors to take her insurance company’s payment in full for services rendered or she will file for bankruptcy and they will never see a dime.
That should shut them up.
Just the Catholic nuns doing their charitable good works of extending their vow of poverty to an unsuspecting person.
Did she sign any contract or agreement when she became conscious? If she did not, the hospital had no valid contract to treat her, so probably would have difficulty suing her.
ObamaCare makes these “network” things so small and restrictive its crazy. The GOPe, if it cannot abolish it outright, needs to cut this to pieces.
should have said she was from Liberia and then sued the hospital/ambulance company ...(snark)
And, it is very interesting that her insurance company paid the hospital everything it would have had it been in their network. So, one price for insurance companies but another for people?
She probably would have never come out of the coma or died of the heart attack waiting on a gurney in the hallway of the ER for hours while those in line got treated first and the union thugs took their scheduled breaks.
On the other hand, it would have been "free", so there is always a silver lining, no?
This would be the first time I’ve heard of insurance that doesn’t make an exception for emergencies. However you have to notify them as soon as you can.
The woman is an accounting student at the university.
I guess she found out what was in Obamacare AFTER it was passed...
Must be the worst insurance in the world to not pay for out of network emergency.
Had she gone to the in-network hospital, she’d only have been hit with about $1,500 in expenses. But since she was taken to the other hospital, she now has to pay the huge difference between what her insurance company paid the hospital and what the hospital charges.
The hospital that treated her billed the patient for $254,000. Her insurance company paid $156,000, which is 100% of what it would have paid to an in-network hospital. That left a balance of $98,000, which the hospital slashed after negotiations with the patient, but still leaves her with bills from individual physicians, the ambulance service and other charges.
Anthem is pointing the finger at the hospital, saying that the insurance company can’t control the prices at a hospital it doesn’t have a contract with.
For one thing, I would like to point out that there is actually a difference in a provider or hospital “accepting” your insurance plan and a provider or hospital “participating” in your insurance plan. In this situation the out of network hospital was willing to accept payment from her insurance company to the tune of $156k but since the hospital didn’t “participate” in her insurer’s plan, they won’t accept the insurer’s in-network fee schedule as payment in full and are therefore free to balance bill the patient for the difference. When you are looking for a doctor, make sure to ask if he/she “participates” in your insurance plan and not merely “accepts” your insurance.
Of all the numerous things to hate about ACA (Obama Care), this is not one of them.
This sort of thing happened long before “Obama Care” and in fact one of the provisions if ACA is that insurers must pay for out of network ER visits, apply to their deductible, co-pays and co-insurance and out of pocket maximums the same as if in-network, were as prior, in some cases, the insurer wouldn’t pay anything to the out of network hospital or pay anything without a pre-authorization, although most would cover at least to the in-network coverage level if the patient truly had a medical emergency, i.e. was incapacitated and taken by ambulance to the nearest available ER even if out of network.
But I also know personally of a few cases where the patient (my brother was one) was taken to the ER via EMT ambulance because at the time they believed it was an urgent life or death situation (i.e. shortness of breath, chest pains) but after the trip the ER and examination and tests, it was found it was something like severe indigestion and not a “true” emergency. The insurance company(s) in those cases refused to cover the ER visit because it was not deemed to be an emergency (but only after the fact) and the patient didn’t call to get a “pre-authorization”.
From Anthem’s website:
Emergency room services – In the event of an emergency, this provision allows individuals to seek emergency room services from in or out of network emergency rooms without pre-authorization for services (post-treatment notification requirements are permitted).
Insurers must cover out-of-network emergency room services, and copayments and coinsurance for these services cannot exceed those for in-network emergency room services. Other types of cost sharing (e.g., deductibles and out-of-pocket limits) are allowed on out-of-network ER if it is the same cost sharing as imposed on other out of network benefits. Health plans must pay the out of network provider the greater of the following: their median payment to in-network ER providers, the amount that would be paid if the plan used the same method for ER as it uses for other out of network services, or the amount that would be paid by Medicare. Members can continue to be balanced billed by the out of network provider.
http://www.anthem.com/provider/noapplication/f1/s0/t0/pw_b148225.pdf?refer=ahpprovider
This is not the fault of her insurance company as they paid as per her plan provisions and contract, exactly what they would have paid for an in-network hospital, but is the out of network hospital playing hard ball with the “balance billing” and not accepting her insurance company’s “in-network” payment as payment in full.
If I were her, I would (or have my attorney) look into what insurance plans this hospital does participate in and what those insurers would pay for the very same services in-network. If those insurance plans with whom the hospital and attending physicians do participate in, pays less than my insurance at the in-network reimbursement, I would tell them, I will only pay that difference. OTHO if those insurance plans with whom the hospital and providers participate in, pay more, I would tell them they need to reimburse my insurance company for the difference. It might not work but I’d tie them and their billing department and attorneys up good and long enough that that they might be willing to negotiate more and bring down that $50k balance to nearly nothing.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
Just a reminder if you get sick away from your network.
The out of pocket max does not apply...
Cardiac arrest means she was dead. The ambulance had to go to the nearest hospital by law. The ER saved her life. She is upset about her life being saved?
The HMO Act written by Teddy K needs repealing. HMO's have all but destroyed affordable care and true private insurance coverage. It became a huge money maker for parent insurers who own most of them. Jack up actual insurance policy cost {which requires covering it's risk} and offer instead a rationing system.
The person was unable to communicate and had she been able to do so under those conditions it would not have mattered. She was going where Trauma Protocol dictated. This system is done to save lives and so the responders and hospitals have an orderly system to go by. There is no corporation I loathe more, none is more corrupt and influences government more than Insurers. Many are corrupt to their very core. I'd go as far as to say over 75% plus of the laws and codes on the books were written solely to lessen the insurers monetary losses.
In Texas, you have a different deductible for out of network services, but once it is met, the insurance carrier must pay (albeit usually with a different coinsurance rate).
However, if the patient has no viable choice for selecting an out of network provider (and an emergency situation is an example commonly cited), then the insurance carrier must pay the claim as though it were in network -- same deductible, co-payment and coinsurance.
Bottom line: Either the lady is incredibly stupid and ill-advised, or there is a lot more to the story than what is being reported here.