In network and billed for $1,400: “Cracking the Code” looks at balance billing

Filed Under: Costs, Health plans, Patients

“Steve Fair woke up at 2 a.m. in his room at the Sheraton New Orleans to find that his uvula – the tissue that hangs from the back of one’s palate – had swollen to the size of a Hershey’s Kiss. Worried it might block his airway, he and his wife rushed down to the lobby and hailed a cab for the nearest emergency room,” our partner Jed Lipinski writes over at NOLA.com I The Times-Picayune.

“Fair, 64, the sales and marketing director for Clement Foods in Oklahoma, was in town on a business trip. At the Tulane Medical Center ER, he paid the $300 deductible that his insurance provider, Aetna, requires for in-network for emergency services, he said. The doctor on call peered into Fair’s mouth, diagnosed him with strep throat, and administered a penicillin shot, reducing the swelling. The whole procedure lasted around 10 minutes, Fair said.

“A month later, back in Oklahoma, Fair got a bill from Schumacher Clinical Partners, a physician staffing company based in Lafayette, La. The bill said he owed $1,360 for the ER physician’s fee at Tulane, the records showed. Fair was appalled. He feared he was being price gouged.

“‘There’s no way to justify charging that much for a 10-minutes doctor’s visit,’ he said during another recent trip to New Orleans.

“Fair sent a letter to Tulane Medical Center asking if they knew that a third-party billing agency was charging him an ‘astronomical’ fee for his emergency room visit in April, he said. He also dispatched a letter of complaint to Schumacher. As of May 15, he said, he had yet to hear back from either one.” Jed Lipinski, “This man went to an in-network ER in New Orleans. Why did he get a $1,360 doctor’s bill?” NOLA.com I The Times-Picayune.

Jeanne Pinder, NOLA.com I The Times-Picayune, “You’re at an in-network hospital, but is the ER doctor in-network?” 

Lee Zurik, “Third-party medical bills a shocker? Welcome to ‘balance billing.'” To watch Lee’s story on WVUE FOX 8 Live, click on the link here or on the image at right.

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