Huge Out-of-Network E.R. Bill? One Big Reason Why It May Be Illegal

Have you received a bill from a hospital for an emergency room visit and suddenly received a huge bill saying that your health insurance won’t pay because it was “out-of-network?”  

Well, there’s a movement afoot where medical providers, particularly hospitals, hire ER doctors or ER related services on an “independent contractor” basis and then claim that those contracted ER doctors and medical providers are “out-of-network” for purposes of health insurance coverage. The result is that the patients receive a huge ER bill which is not covered by their health insurance company on a discount basis as an “in-network” service.  The issue was raised in an informative article appearing in HealthlineNews entitled “Slammed with a Huge ER Bill from an Out-of-Network Doctor or Hospital?  Now What?” The New York Times also ran a recent article with the headline, “Costs Can Go Up Fast When E.R. Is In Network but the Doctor’s Are Not.”

The stress caused by the size of these surprise ER bills is enough to put someone back in the hospital.  The good news is that patients have legal rights.  You have to remember that patients are, essentially, consumers of insurance and hospital services.  As consumers, patients have a contract with their health insurance company, called their health insurance policy, for which they have paid a high-priced premium.  Patients have also entered into a contract for medical services with their medical provider. Your health insurer and medical provider are obligated to honor their contractual promises and treat you with a duty of “good faith.”  In addition, your health insurer and medical provider have to comply with state and federal consumer protection laws.

There is a set of consumer protection laws that exist in most states that prohibit unfair and deceptive business acts and practices.  For example, Massachusetts’ consumer protection laws are found in “Chapter 93A” and are some of the most powerful consumer protection laws in the country.  At the heart of all consumer protection laws is the requirement that businesses adequately disclose charges and fees to consumers.  The hospital’s scheme of not disclosing which doctors or related medical providers are independent contractors hired by the hospital is unfair and deceptive.  The practice of not disclosing the fees associated with these independent contractors is also unfair and deceptive.  There is no way for a patient, who sought treatment on an emergency basis, to even know which treating providers are “independent” from the hospital and the amounts they charge for a given service.

Patients, as important consumers of healthcare services, need to be aware that the consumer protection laws apply to medical providers and offer protection against huge out-of-network ER bills.

Phillips & Garcia, LLP is a consumer protection law firm with experience protecting consumers from out-of-network health insurance overcharges.  Click here to e-mail your out-of-network billing questions to our attorneys.

Disclaimer:  The attorneys at Phillips & Garcia, P.C. are licensed attorneys in Massachusetts.  They cannot represent clients in other states without first associating with licensed local counsel in states other than Massachusetts.  They also cannot represent consumers in other states in state or federal court without first obtaining or associating with local counsel and obtaining approval from a judge to practice in another state on a case by case basis.

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