By Consumers For Quality Care, on March 4, 2020
A report in the Georgia Health News highlights one family’s experience with surprise billing in Georgia.
It all started when Lelia Stina’s four-year-old son, Liam, was having breathing problems. Lelia immediately drove him to a hospital in their insurance network. While Liam was being treated at that hospital, doctors recommended he be transferred to a different hospital, Floyd Medical Center, because it had more capacity to handle pediatric care.
Although Floyd was not in the family’s network, Lelia didn’t want to take any chances and followed the doctor’s advice to transfer Liam.
Because Liam’s situation was an emergency, Lelia thought he would be covered. But she was soon surprised with a bill for over $11,000 from Floyd Medical Center.
In terms of surprise medical bills, this one was a whopper.
“I’m extremely disappointed,’’ says Stina, who has appealed the case to the state insurance department.
The Stina family had an insurance exchange HMO plan from Anthem and Floyd Medical Center was out-of-network for the plan. Lelia’s assumption that they would be covered turned out to be wrong.
But under the insurance policy language, that’s not the case, Gatton says. Insurers will “cover” a claim, but because a doctor or facility is not contracted for that plan, legally they can accept the payment, but not as payment ‘‘in full.’’
Floyd thus was allowed under the health plan to “balance bill’’ the family, requiring them to pay the remainder of the charges, Gatton says.
Lelia has filed a complaint with the Georgia insurance department over the bill.
“These institutions are monsters,’’ Stina says. “I work very hard. I pay my bills. I don’t feel like the system cares about me very much.’’