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Hospital visits can mean huge out-of-pocket costs for families who struggle with surprise bills

Stethoscope with money dollar on Blue background. medical concept
Posted at 2:14 PM, Jan 14, 2021
and last updated 2021-07-27 17:22:55-04

PHOENIX — If you've been an emergency hospital patient, you may have been surprised by the bill that comes later.

Even patients who have insurance can be hit with thousands of dollars in bills, like the case for Maria Gonzalez.

She took her daughter to a clinic and was then referred to a Banner Health emergency room, thinking the daughter had appendicitis.

It turns out it was not that serious and at first, Gonzalez thought her portion was not a problem either saying she owed just $436 of the $9,000 charged.

But then she says, that changed.

Gonzalez says she was told she had to pay more than $7,000, which would mean she'd have to pay $643 a month for a year to pay it off. Gonzalez is a stay-at-home mother who says her husband doesn't make enough money to cover the bill.

She added she didn't understand it because her hospital was in her insurance network and covered fully.

Surprise medical bills hit families hard and in most cases, patients find that while their hospital is considered in-network by their insurance provider, a doctor may not be. This means the patient is responsible for the large out-of-network cost.

A new law will be changing that next year. Beginning in 2022, if you get care in an emergency room, you will be billed at an in-network rate. The same thing will be true if you receive non-emergency care at an in-network hospital but are unknowingly treated by an out-of-network doctor or lab.

However, that doesn't help Gonzalez with her current financial situation.

"It has been so hard to deal with them, so stressful, calling them back and forth and getting the same answer," she says.

When Gonzalez reached out to the Let Joe Know team, we went to Banner Health and asked them to investigate. They did and said their billing was "accurate and appropriate."

We then went to the insurer, Bright Health, and received some great news.

They wrote to Maria saying that an "adjustment was out of your control."

In a statement to ABC15, the insurer said, "Bright Health appreciated the opportunity to help resolve Ms. Gonzalez's billing issue. As soon as it was called to our attention, we were able to assist the out-of-network provider and the collections agency process the payments Bright made on her behalf. No further payment is required by Ms. Gonzalez."

After Bright Health helped with the billing issue, Gonzalez did not have to pay any more than the $500 co-pay she says she already paid.

While she dealt with this for far too long, having Bright Health investigate and figure out what exactly was happening with Gonzalez's hospital bill made a significant difference for Gonzalez's case.

If you have a planned hospital visit, make sure to go over your insurance coverage before you arrive. Request that all care, including doctors and labs, is considered in-network by your insurer and try to get that assurance in writing.

For more on the new surprise medical bill legislation, click here.