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Russell G. Small

Many patients surprised by out-of-network medical bills

Even when Connecticut patients seek care at an in-network hospital, they may be faced with surprise out-of-network medical expenses. In fact, roughly 1 in 7 patients are surprised by medical bills, according to data on medical billing processes and practices. An analysis of more than 600,000 in-network inpatient admissions found that instances of at least one out-of-network claim ranged from nearly 2 percent of all admissions in Minnesota to nearly 27 percent in Florida.

Out-of-network expenses that may result in some degree of medical debt tend to involve anesthesiology and independent lab services. Specialties representing the most out-of-network professional claims also include primary and non-physician care, emergency medicine, and radiology. The "surprise" bills often occur when a patient goes to an in-network provider and needs services that are inadvertently assigned to out-of-network providers. Unfortunately, patients often have no control over out-of-network care, nor do they always get straight answers when seeking such information.

There have been some initial efforts to consolidate multiple bills from different sources into a single statement, but not on a widespread scale. Researchers further broke down data related to surprise billing by state to get a better idea of what's working well in states with lower out-of-network claims. Capping out-of-network charges based on regional averages is one of the solutions legislators have suggested to deal with surprise billing issues. Experts at a symposium related to this topic noted the need for industry stakeholders to also sit down and attempt to resolve this issue.

For times when medical bills put a serious strain on a patient's budget, a bankruptcy attorney can discuss options. Before recommending personal bankruptcy, however, a lawyer may suggest making an effort to negotiate payment arrangements with medical providers without involving the court. If this isn't possible, appropriate documentation can be prepared by a lawyer to get the bankruptcy process started.

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