Several years ago my son cut himself at work. Fortunately he received only a minor injury. He went to a local university hospital where a nice medical student cleaned his wound and gave him two stitches. He did not see a physician- ever- during that visit. As a practicing physician in another university hospital I wasn’t terribly concerned until I got a bill from the hospital and the physician.
There were two problems with the bills. The first was that both bills were in excess of the contractually allowed amount under my insurance coverage (both the physician and hospital in-network providers on my insurance). The other problem is that physicians may not collect for services they don’t actually provide.
The hospital tried what is commonly know as balance billing. I had read my insurance contract so I knew it was prohibited. I can read an EOB (explanation of benefits) so I understood where all the charges were coming from and what was permitted. The physician was, incontrast, committing fraud. Being a knowledgeable physician and consumer I called the hospital and the physcian’s office. Although I spent quite a bit of time on hold with both I eventually got the physician bill dropped altogether (I also informed the insurance company so they wouldn’t pay either). The hospital reduced the bill to something entirely reasonable.
Most insurance companies do not allow in-network hospitals or physicians to balance bill patients. Patients have an obligation to understand the EOB and only pay what is required. Patient must carefully read and understand their insurance contract. If you have questions call your insurance company.
It’s your health and your money. Protect them both.
