Most of us expect that if we choose a hospital or other facility in our insurance network, then we will be treated by in-network staff. You would be wrong.
The problem is, you often won't know about, until you get the huge bill in the mail weeks later. And by that point it's too late.
The industry calls it balance billing, meaning you are being billed for the balance that insurance did not cover.
And in Arizona, it also means you are stuck appealing to your insurer to cover the bill, begging the provider to lower the price or going bankrupt trying to pay it.
It is an incredibly unfair system. But there is something you can do about it.
According to Claire McAndrew, with health insurance advocacy group, Families USA, state legislatures around the country from Washington, to Pennsylvania to Florida, are considering bills that would provide some form of consumer protections against the practice.
"There needs to be some sort of change to the system because consumers can't continue to get hit with these surprise bills," McAndrew says.
We found Texas, Maryland, California and Colorado already have laws on the books to protect consumers. Protections range from explicit mandatory disclosure that a provider is out of network, to requiring that insurers and providers having to mediate a resolution with one another--holding the patient harmless.
The strongest protections are in New York. In many cases the practice of balance billing is banned altogether. The state also requires explicit disclosures about which providers are not in-network.
But these changes didn't magically come about. Neither the insurance nor the medical industries decided out of the goodness of their hearts to crack down on balance billing. Consumers decided enough was enough and started complaining any government agency that would listen. From the state Attorney General, to the state's Department of Insurance, to your representative in the State Legislature.
If people complain frequently and loudly enough--you can't be ignored for long.
So this time don't let me know about it, tell the one's with the power to do something about it.
Arizona Department of Insurance
Arizona Attorney General Office
Need my help or want to volunteer to help others as part of the Assistance League of Phoenix team, call us at 855-323-1515, find me on Facebook or Twitter.
You can also send me a video of your problem to Joe@abc15.com or sign up for our monthly newsletter here.
