Hospital emergency room visits keep increasing from COVID-19. One question that keeps coming up is:Do insurance companies have to cover my medical bills from an emergency room visit for both in-network and out-of-network providers?Yes. But that was not always the case.
You might know that your local hospital is on your insurance plan. But medical bills from a hospital visit are complicated. One statement may be from the hospital and a separate bill from the emergency room doctor, radiologist, or lab.
If you went to a hospital on your plan, the insurance company would still deny some of the expenses as being out-of-network. Experts call them “surprise bills” because you thought everything at the hospital would be covered. After all, it was on your plan.
But when the hospital lab submitted its bill to the insurance plan, the payment was rejected. The insurance company’s reason- the lab in the hospital was out-of-network. Instead, a lab down the street is in-network. Studies show these surprise bills vary by state, but the average is 18%. of all visits had surprise bills. https://www.kff.org/health-costs/issue-brief/an-examination-of-surprise-medical-bills-and-proposals-to-protect-consumers-from-them/
It was a ridiculous situation because a patient was in no position to get care from an in-network provider. Could you imagine lying in a hospital bed hooked up to monitors, and be forced to run across town for bloodwork with someone in-network?
Fortunately, Florida forbid this practice in 2016 in Florida Statute 627.64194. https://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0627/Sections/0627.64194.html
Unfortunately, insurance companies still attempt to deny claims as being out of network, despite this law.
If your insurance company denies hospital bills because they are “out of network,” call Dyson Law PLLC today at 561-903-4542.