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This article is VERY misleading. I worked in the industry for over 30 years.
A doctor or hospital is considered in-network when they have agreed to accept your insurance. That means they agree to your insurance carrier's fee schedule. The contract between doctor and insurance carrier means the doctor cannot balance bill. Meaning: the doctor charges $200 for a routine visit. The carrier says that visit is only worth $100. The doctor is under contract to accept the 100 and CANNOT go after you for the balance, the other 100.

A non-contracted (meaning out of network) doctor can charge you whatever they want. Having insurance protects you from crazy high bills.

So, you go to a in-network hospital but you don't know that all the ER doctors there are not contracted with ANY insurance carrier. They can balance bill you. They REFUSE to accept any insurance carrier's fee schedule because they know they can charge you whatever they want, you are a captured audience, unknowing what is coming your way.

It's not the carrier's fault. It's the doctors that refuse to be in-network for ANY carrier. This happens a lot with anesthesiologist too. Blaming only the insurance companies is just wrong.

“The contract between doctor and insurance carrier means the doctor cannot balance bill.”

But it’s attempted anyway and too many people just pay it without questioning it. I’m afraid the HMO is going to go away as the doctors are aware of what they are losing and there is a steady amount of “paying” patients so they don’t need the guaranteed patient anymore. The offset cost cuts into their vacations in Tahiti I guess.

rwood

Maybe that is how it is supposed to work, but that’s not at all how it is implemented. Balance billing happened in my case 100% of the time.

I will never forget the aggravation and stress of trying to recover from a major surgery and literally fighting with both insurance companies,hospital billing departments, and finally bill collectors about what everyone was contracted to cover and what everyone was contracted to pay.

Let’s just say that no one ...NO ONE... was helpful in my recovery process. It was so stressful that when the time came for my physical therapy to begin I told them to ‘GET THE HELL OUT OF MY LIFE AND HOUSE.’ Over a year later I still had bill collectors calling on some bills, told them to call the insurance company.

I haven’t seen a doctor since then. I pay for an insurance I will never ever use. And I have resigned that I will die due to inability to reasonably be able to use or access medical treatment.

Congratulations you greedy bastards. Don’t bother trying to save my life only to suck my soul right out of me. You killed many times over already.