When Insurance Covers the Hospital Visit, Just Not the Doctor

The Jackson Clarion Ledger reports on a local story, but one that impacts people all around the country every single day:

Michelle Mills made sure to check that River Oaks hospital in Flowood was in her insurance carrier’s network on her way to the emergency room last fall.

Her child had experienced a sports injury after colliding with another player, fracturing his nose.

So when Mills got a separate bill from the out-of-network emergency room physician — whom she said she never even saw — she was perplexed.

The doctor had charged $1,853. The insurance carrier paid $38.

Essentially the Mills family was billed for the difference between the amount billed and the allowed amount. This is called a “balance bill” — a practice prohibited by a state law that is neither consistently enforced nor interpreted.

According to a Yale University report published in the New England Journal of Medicine in 2016, patients visit in-network hospitals but receive some out-of-network charges in nearly one-fourth of emergency episodes.

For more information on the issues surrounding medical debt, please contact RIP Medical Debt.