Surprise medical billings

Covered. Your health plan covered your surgery, or maybe childbirth. At least that’s what you thought — the hospital or clinic was in your plan’s network.

Then surprise ... bills start pouring in afterward. Thousands of dollars for a surgeon who assisted, or anesthesiologist ... or consulting doctor.

And you’re directly billed for their services — out of your pocket.

Surprise medical bills happen increasingly often. Your medical facility brought in personnel who are out of your health plan’s network. Maybe a physician when a nurse would’v been enough. Or extra tests or medical equipment were ordered.

Nor were you told in advance or given a chance to shop around.

The scams

The price you pay

Fight back


The scams

Surprise billings can be perfectly legal, though unwelcome and financially draining.
Yet sometimes you’re also victimized by outright fraud

Crooked doctors may illegally bribe colleagues to be included and billable in your surgery or other medical procedure. These are called kickbacks.

Bills can be fraudulently inflated — many times the norm. And you’re told to pay up.


The price you pay

You’re on the hook for thousands of dollars in surprise medical bills.

Your credit can be damaged if you can’t pay the bills on time.

Resolving the problems can cost many hours of aggravation — when you’re healing from surgery or another procedure.


Fight back

Before you get treatment ... If possible, ask your health insurer, doctor and hospital what bills you’ll have to pay. Also ask for the projected cost. Get a signed and written agreement.

Shop for the best deal that’s covered by your health policy.

After treatment .... Appeal surprise bills to your insurer. Request that the insurer pick up the extra tab.

Contact your the medical facility and your health insurer to help clarify the bills. Check for treatments or medical equipment you didn’t receive. Your employer also might help if it’s a company-provided health plan.

Ask your health insurer if a senior claims examiner can review the claim.

Some states protect you from certain surprise bills. This is especially true of medical emergencies. Check with your state insurance department for more information.

Consider seeking a state-level consumer advocate for help.