Consumer Reports: Surprise ER bills even if you have insurance

Posted at 6:05 PM, Oct 05, 2016
and last updated 2016-10-05 18:30:33-04

A potentially lifesaving trip to an emergency room could result in exorbitant and unexpected bills even if you have insurance. About two-thirds of emergency room doctors are independent contractors and they might not be covered by your plan.

To avoid shocking ER bills, Consumer Reports advises doing your research before an emergency happens. Contact your local hospitals. Ask if they take your insurance. Then ask your hospital of choice whether the ER doctors there will take your insurance, too. Doctors can bill you for what your insurance doesn’t cover.

Ambulances, lab services, and special equipment can also fall into the out-of-network category, potentially costing you thousands of dollars. Consumer Reports says if you get out-of-network bills, don’t pay anything until you get an E-O-B — an explanation of benefits — from your insurer. Compare that with the bills. And confirm with your insurer that the providers are not in your plan.

Then ask your provider if it will settle for what the insurance company has already paid. Be persistent. You’ll be surprised; some doctors will negotiate with you. You can also appeal to the agency in your state that regulates insurance carriers. You can check here for contact information for all states. In Michigan, that agency is Michigan's Dept. of Insurance & Financial Services.

Several states, including New York, Florida and California have laws on the books to prevent people from being charged out-of-network fees for hospital doctors in emergency or other situations. So Consumer Reports says don’t pay a surprisingly-high ER bill without checking first with your provider and insurance company.  

For additional guidance, call the Patient Advocate Foundation, which offers free, personalized counseling to resolve problems with medical bills. Their toll-free number is 800-532-5274.

Complete Ratings and recommendations on all kinds of products, including appliances, cars & trucks, and electronic gear, are available on Consumer Reports’ website.