(BPT) – Patients receiving medical care increasingly also receive something unexpected and troubling — a bill they thought would be paid by their health insurance plan.
Without knowing, patients may be treated by physicians or providers outside their health insurance network who are paid at a lower rate than an in-network physician. Patients are then expected to pay the difference between the actual charge for the medical service and the lower amount the insurance companies agree to pay. These out-of-network payment issues are caused by gaps in insurance coverage.
“Health insurance plans are extremely complicated, and even savvy consumers face uncertainty about what is covered by their health insurance,” says Jeffrey S. Plagenhoef, M.D., president of the American Society of Anesthesiologists (ASA). “My own wife recently received a surprise medical bill despite being a physician herself and researching our insurance policy in depth ahead of time.”
During Physician Anesthesiologists Week (Jan. 29-Feb. 4), the ASA wants to empower patients to be informed health care consumers by alerting them to three things they should know about “surprise insurance gaps.”
1. Before having a medical procedure, ask who will be involved in your care and whether they’re in your plan’s network. Also, call your insurance company to verify that not only the hospital or medical center, but also your particular physicians and other providers are in-network.
2. Low premiums don’t necessarily mean affordable care. Always ask for details about what the health insurance plan covers and doesn’t cover before signing up to protect against high co-pays, deductibles and a plan with a narrow network of physicians.
3. “Surprise medical bills” are caused by “surprise insurance gaps,” or gaps in insurance coverage that occur when the insurance plan offers a low premium but limits the number of physicians available to patients in the plan’s network. Insurance plans with narrow networks remove or reduce patient choice by providing coverage with a limited number of physicians, high deductibles, co-pays and coinsurance. These inadequate networks limit insurance companies’ costs and shift them to patients and other stakeholders.
“Physician anesthesiologists are committed to safe, high-quality care for all our patients,” Dr. Plagenhoef says. “This means not only overseeing your care in the hospital or the office, but advocating for you with legislators, hospital administrators, insurance companies — everyone who plays a role in making sure patients get the care they deserve, which is the best care possible.”
To learn more about the critical role physician anesthesiologists play before, during and after surgery, visit asahq.org/WhenSecondsCount.
