Why Cancer Patients Are Legitimately Frustrated with Medical Billing
When my first husband, Ahmad, was diagnosed with metastatic bladder cancer, the disease and prognosis were challenging enough. Dealing with the medical bills was its own devastation.
Deciphering medical bills
Cancer patients and their families spend much of their time deciphering medical bills. I never paid a medical bill until I was satisfied that I understood how the amount we were asked to pay was consistent with our insurance coverage. This was often not easy to determine. The system is convoluted and places an enormous burden on patients and their families to sift through bills and rules. And one appointment, treatment, or procedure can generate multiple bills.
The hospital’s chief of vascular surgery responded and treated him in the ER and performed emergency surgery soon after. This doctor was excellent in his responsiveness and treatment. Ahmad was then hospitalized for about 10 days. The hospital was in our network and we had been there before so we didn’t question whether any of this would be covered.
Then the bills rolled in
As the bills rolled in, we quickly realized this was a more than $250,000 hospital stay. Scary if you think about it for more than a moment. But we had great coverage and most bills were fully paid by our insurance for which we were very grateful. We received a “facility” bill from the hospital, separate bills from various doctors who treated him while in the hospital, and another bill for the ambulance ride.
One of the doctors’ bills was for several thousand dollars from that vascular surgeon in the ER. I couldn’t understand why, if the ER was supposed to be fully covered under our plan, we were getting this bill.
Not in-network
The explanation I received was “oh, that particular doctor is not in your network.” But how were we supposed to know that if the hospital was in our network? Should we have asked (in the middle of the medical emergency in the ER), “is this doctor in our network?”
And if we had received the answer of “no,” what would have been our recourse? He was the doctor on call and the head of vascular surgery. Would we have a requested a list of in-network doctors and asked if one of those doctors was available? Would we have gone to a different hospital? Would these options even have been practical/possible in the middle of the blood clot medical emergency?
A conundrum for cancer patients
I later learned two key pieces of information that are essential to understanding the maze of hospital billing as a cancer patient. One was that it is, as shown by our experience, possible to go to a hospital in your network and be treated by a doctor who is not in your network. I don’t understand what recourse patients are supposed to have to opt out of this out-of-network treatment, especially in the middle of an emergency. This is kind of like buying a refrigerator with a warranty and then finding out that the cooling element is not covered by the warranty. It wouldn’t even occur to you to ask whether that particular part was covered.
Balance billing
The second thing I learned was that out-of-network treating doctors in this instance can bill you for their services. This is a practice called “balance billing” and it is legal in many states and illegal in a few states.
We were lucky: balance billing is illegal in California and so, because I kept asking questions about this bill, we did not have to pay the roughly $4,000 billed. While we greatly appreciated this surgeon’s skill and work, it seemed his work should have been covered by our insurance plan, which it ultimately was.
A tall order
Ask questions, follow up, and make sure you understand a medical bill and how it relates to your coverage benefits before you pay it. This is a tall order when you are also dealing with the medical challenges of cancer.
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