We have one of the most complex, inefficient healthcare systems in the world, which is routinely brutally unfair to individuals who need help. What this article describes is insane, and should be illegal. Yet, it's just one teensy problem among hundreds which ensure that medical bills are the #1 driver of bankruptcy in this country.
On January 28, 34-year-old Scott Kohan woke up in an emergency room in downtown Austin, Texas, with his jaw broken in two places, the result of a violent attack the night before.Witnesses called 911, which dispatched an ambulance that brought him to the hospital while he was unconscious.
“The thing I remember most was my lips were caked in blood and super dry,” Kohan says. “My head was throbbing, so I touched the top of my head, and I could feel staples there.”
Kohan called for a nurse, who explained that he would need jaw surgery that night. In the meantime, he tried to check whether the hospital — Dell Seton Medical Center — was in his insurance network.
“I was on my iPhone lying there with a broken jaw, and I go on the Humana website and see the hospital listed,” Kohan says. “So I figured, okay, I should be good.”
Except he wasn’t: While the emergency room where Kohan was seen was in his insurance network, the oral surgeon who worked in that ER was not. That’s how Kohan ended up with a $7,924 bill from the oral surgeon that his health plan declined.
“In hindsight, I don’t know what I could have done differently,” Kohan says. “I couldn’t go home. I had a broken jaw in two places. I tried to check if the hospital was in network.”
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“It does happen quite a lot in the emergency room,” says Christopher Garmon, an assistant professor at the University of Missouri Kansas City.
Garmon published a study last year that found as many as one in five emergency room visits led to a surprise bill from an out-of-network provider involved in the care.
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Unless states have laws regulating out-of-network billing — and most don’t — patients often end up stuck in the middle of these contract disputes.
These surprise bills appear to be especially common in Texas, where Kohan lives. Garmon’s research, for example, finds that as many as 34 percent of emergency room visits lead to out-of-network bills in Texas — way above the national average of 20 percent.
Separate data from the Center for Public Policy Priorities, an Austin-based think tank, finds that a staggering number of Texas emergency rooms have zero in-network emergency physicians — meaning that patients are guaranteed to see a doctor who does not accept their health insurance.