If you’re one of the countless number of Americans who’ve gotten a surprise bill from a health care provider, even though you have insurance, good luck.
Even if you complain to your state insurance department, you’re not likely to get much if any help.
I was in Nashville a few days ago to give a talk. One of the other speakers was the Tennessee director of insurance. She was there to talk about the growing problem of people with insurance getting surprise bills from doctors and hospitals for services they assumed would be covered by their health plan.
It turns out that a few weeks earlier, BlueCross Blue Shield of Tennessee notified the state insurance department that it was kicking a group of anesthesiologists out of its health plan networks. Not just any group of anesthesiologists, mind you, but the biggest one in Tennessee. The one that serves just about every hospital in Nashville and a big chunk of the rest of the state.
So what did the director of insurance say the told BlueCross? “Please work that out.”
She said 80% of patients at blue Cross’s in-
network Hospitals use that anesthesiology group
BlueCross, of course, was not intimidated. It went ahead and put its customers on notice that in a matter of weeks, if they had to have surgery and were put under while on the operating table by one of the doctors they were kicking out, they would get a big bill for it. Blue Cross would only pay if you were having an emergency.
Folks, when was the last time you were in the hospital and you had the presence of mind to ask the anesthesiologist—just before he knocked you out—if he was still in your health plan’s network? Well if you’ve ever done that, please let me know. I want to hear from you and find out what happened next.
What if you were a Blue Cross customer and had to have your gall bladder taken out but you hadn’t heard that most of the anesthesiologists at your hospital were no longer in your network. Well, as Gomer Pyle used to say, Surprise, Surprise.
You would have gotten a surprise bill, and undoubtedly a very big one. Anesthesiologists don’t work cheap.
Here’s what you need to know. Insured patients all over the country are getting big surprise bills these days as more and more insurance companies do what BlueCross threatened to do.
Fortunately for the folks in Tennessee, Blue Cross and the anesthesiology group came to an agreement on a new contract at the 11thhour. But it wasn’t the result of any real threat by the Tennessee Department of Insurance.
State regulators don’t even have jurisdiction over many of the policies health insurance companies sell in this country. Know this, if you are in an employer-sponsored health plan—in any state—you’ll be wasting your time complaining to your state insurance commissioner when your health plan shrinks its provider network on you with little advance warning.
When you sign up for a health plan, you absolutely have no guarantee that the doctors and hospitals they tell you are in your network will still be in your network six months later. And you, not they, get stuck with a very big bill.