By Consumers For Quality Care, on October 9, 2018
Steve Zangla waited as long as he could but eventually his stomach pain became unbearable. Steve and his wife Colleen went to the emergency room at Riddle Hospital in Media, PA. The Zanglas had positive experiences at the hospital before. Once there, the Zanglas learned that Steve had a kidney stone.
Weeks later, they were shocked to receive a bill for nearly $700. They had chosen Riddle Hospital, at least in part because they knew it was in their insurance network. Unfortunately, the doctor who treated Zengla was not. The couple had not yet met their deductible and were responsible for the bill, The Inquirer reports.
“So let me get this straight,” said Colleen Zangla. “We’re in the ER, we’re having an issue, we’re not thinking about insurance other than we’re in the right hospital — and we have to ask for the right provider?”
The Zenglas, like throngs of other Americans, had received a surprise bill.
Surprise billing is the term for what happens to patients who try to follow the rules of their insurance plan, but get tripped up as the Zanglas did. Sometimes it’s an ER doctor who isn’t covered under the same contract as the hospital where he works. Sometimes it’s an anesthesiologist with a different contract than the surgeon and the surgical facility.
The couple paid the bill when they received it, thinking it was useless to dispute. However, since hearing from The Inquirer, representatives from the hospital and insurer have said they will process the Zanglas’ bill.
Many consumers are not so lucky. Often, they find themselves trying to navigate the contracts between insurers and hospitals to avoid surprise bills.
“It’s so difficult for providers and insurers to come to that agreement,” said Kevin Lucia, a research professor at Georgetown University’s Center on Health Insurance Reforms. “They end up kind of pulling consumers in, so consumers end up being used, in a way, to mitigate the expense.”
Even with stricter provisions, it can be difficult for consumers to know when they have received a bill in error.
I kind of always thought, ‘Oh, they’re right, you’re wrong,'” Zangla said of her initial reaction.
Next time, Zangla says she will call and inquire about a surprise bill before paying.