NY Times: Out of Network, Not by Choice, and Facing Huge Health Bills

Donna Alberico for The New York Times

Sienna D’Andrea was treated by out-of-network doctors.



Once the cardiologist figured out why Raquel and Michael D’Andrea’s 9-week-old daughter was so frail and unable to eat, he immediately sent her to the hospital for heart surgery. 

Donna Alberico for The New York Times

Sienna D’Andrea, 9 months old, with her mother, Raquel, and grandmother Livia, who spent weeks deciphering and renegotiating Sienna’s medical bills.

“He told us to go home, get packed and get to the hospital, where they will be waiting for us,” Ms. D’Andrea said. “That was very shocking, but we did it.”

There was little time to think about the intricacies of their insurance plan, but Ms. D’Andrea knew she had already selected a comprehensive plan a few years earlier. She gave herinsurance card to the hospital staff, but her daughter, Sienna, was ultimately treated by several doctors who were not in their plan’s network.

“We assumed that because we showed them our insurance card and nobody had any objections, we were covered,” said Ms. D’Andrea, 35, of Farmingdale, N.Y. “But I also wasn’t in the mind-set to ask, or to have them stop doing heart surgery on her.”

Sienna left the hospital in early March, two weeks after a successful operation repaired her aorta. But she had a rough road ahead. She went home with a feeding tube in her nose.

And just a few weeks later, after vomiting through the night, she spent another 17 days in the hospital. As the family finally arrived back home in mid-April, piles of bills from out-of-network doctors started to roll in.

It’s not uncommon for patients who visit an in-network hospital to learn later that they’ve been treated by out-of-network providers, resulting in thousands of dollars in charges. And while the Affordable Care Act generally caps what consumers must spend out of pocket when using providers within their plan’s network, it doesn’t protect consumers from large bills from outside providers. Those providers may be free to charge the consumer for the balance of the bill that the insurer did not pay, known as “balance billing.”

Continue reading here: http://www.nytimes.com/2013/10/19/your-money/out-of-network-not-by-choice-and-facing-huge-health-bills.html?_r=0

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