“Balance Billing” Practice Leaves Cyclist with $200,000 Medical Bill

By Consumers For Quality Care, on December 8, 2021

A mountain-bike crash across the country landed Phil Gaimon in a world of hurt, resulting in a fractured collarbone, five broken ribs, a partially collapsed lung and a broken scapula, as well as a medical bill for $200,000.

Gaimon, a California native and former competitive road cyclist, was enjoying a second career as a mountain bike racer when he got into a severe accident in Pennsylvania. He required several surgeries for his injuries, but thankfully recovered. Gaimon, who pays $500 a month for his insurance policy with Health Net through Covered California and has secondary insurance with USA Cycling, received bills totaling over $200,000 from his injuries.

Gaimon faced a scenario all too common with patients that require emergency care from an out-of-network provider, known as “balance billing.” This is when hospitals and insurance companies without mutual contracts can’t agree on the price of services, leaving the consumer to pay the difference.

Cases like this are the reason why CQC stands by the No Surprises Act, which will go into effect next year. The law protects patients against unexpected bills from out-of-network providers, filling one of the major gaps in our health care system that leaves patients vulnerable to astronomical surprise medical bills.