A woman in a small New Mexico community was pregnant and went into labor prematurely.\u00a0 She went to the right hospital\u00a0 — that is, the one covered by her health insurance plan.\u00a0\u00a0 She gave birth to premature triplets. \u00a0Specialists were called in. \u00a0Two of the babies could not be saved.<\/p>\n
Several months later, she and her husband were confronted with more than $3 million in medical bills.<\/p>\n
Heather Widler of the New Mexico Office of the Superintendent of Insurance (OSI) explained what happened. \u00a0The hospital had to call the specialists for this urgent situation. \u00a0The specialists were not contracted with the health plan that covered this family. They were \u201cout of network.\u201dSo they billed the patient directly.<\/p>\n
This kind of complication happens so often in the topsy-turvy world of today\u2019s health insurance system that it has a name:\u00a0 surprise billing.<\/p>\n
According to a Consumer Reports study cited by OSI, 30 percent of privately insured Americans have received a surprise medical bill.\u00a0 Consumers pay an estimated $1 billion annually in these unexpected billing charges.<\/p>\n
Most consumers don\u2019t know what to do, said Widler, when billing issues like this arise.\u00a0 Some pay the bill without asking any questions or raising the issue.\u00a0 Sometimes the paperwork is so confusing to consumers that they send a check when the notice they received was not even a bill.<\/p>\n
OSI wants you to know that help is available from OSI\u2019s Managed Health Care Bureau.\u00a0 You can call the bureau at 1-855-427-5674.
\nIn the case described above, OSI helped untangle the billing complications so the family owed only their contracted annual maximum.<\/p>\n
In cases like this it\u2019s also critical, said Widler, to work with the insurer, the hospital and the specialists so that no party ends up being a big loser.\u00a0 Our institutions cannot afford to absorb big losses, she said.<\/p>\n
OSI is the new state agency created when the former Department of Insurance was separated from the Public Regulation Commission by a constitutional amendment approved by the voters in 2012. \u00a0Now that it is separated from the politically charged PRC, OSI is moving aggressively to develop a number of consumer protection initiatives., including this one.<\/p>\n
One concern is reaching the people who have the greatest need for assistance.\u00a0 OSI has held several public meetings around the state, but that\u2019s not nearly enough to reach people who might be receiving surprise bills.<\/p>\n
(Disclosure:\u00a0 I am a volunteer member of the Insurance Fraud Policy Advisory Group, which works with OSI.)<\/p>\n
Here\u2019s my request:\u00a0 if you are a community leader, or if you are in the health care field and in contact with patients, keep this information in mind and share it with those who might need it.<\/p>\n
Nationally, the Affordable Care Act has reduced some of the strain of surprise billing by requiring that in an emergency, the bill from the hospital itself must be handled as if in-network, even if the patient went to the \u201cwrong\u201d hospital.<\/p>\n
A few states have passed legislation protecting consumers from surprise bills.\u00a0 Others are considering legislation. \u00a0While OSI\u2019s help can protect some consumers from some excessive bills, it does not have the authority to fix every problem.\u00a0 And we have to remember that our state is short of doctors and our rural hospitals are financially distressed, so we can\u2019t simply force them to absorb these costs.<\/p>\n
This surprise billing issue is just one aspect of much bigger problem:\u00a0 our irrational, confusing and overly expensive health care system.\u00a0 Whether you think the Affordable Care Act made the system better or worse,\u00a0 our nation desperately needs to reach a consensus on how to fix it. \u00a0\u00a0Until then, New Mexico should follow the lead of other states and seriously consider a law to protect both the consumers and the providers.<\/p>\n
Triple Spaced Again, \u00a9 New Mexico News Services 2016<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
A woman in a small New Mexico community was pregnant and went into labor prematurely.\u00a0 She went to the right hospital\u00a0 — that is, the one covered by her health insurance plan.\u00a0\u00a0 She gave birth to premature triplets. \u00a0Specialists were … Continue reading