Surprise medical bill: when insurance covers the hospital visit, just not the doctor

April 15, 2018, The Clarion-Ledger, Anna Wolfe- 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. The emergency room doctor works for a physician staffing group, not River Oaks. Mills had no way of knowing that in advance. The bill from Capital Emergency Physicians, which was incorporated using River Oaks’ address but bills out of Oklahoma City, notified Mills the doctor was not in her health plan’s network. “As a result, you may be billed for the difference between the amount billed and the allowed amount,” the bill reads. This is called a “balance bill” a practice prohibited by a state law that is neither consistently enforced nor interpreted.

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