The health care world has many moving parts. As a debt collector, it’s your job to be the health care expert—which means it’s often up to you to explain medical bills and insurance coverage to consumers.
You’ll hear things like, “My insurance should have paid that!” and “I was told I was covered.” In an emergency situation, medical bills get even more confusing. The patient might not even have been conscious at the time of care to consent to the treatment.
The Emergency Medical Treatment and Active Labor Act requires hospitals to evaluate and stabilize patients regardless of their financial situation. These requirements are mandatory and not affected by payment considerations. The hospital still bills the patient, and the patient is responsible for paying that bill.
This is particularly stressful if patients aren’t satisfied with the treatment and find out their health insurance won’t cover it. Sometimes patients go to the emergency room, change their mind and refuse treatment, but are still charged a facility fee. Facility fees are charges for a hospital’s services and equipment, and they often come as a surprise to patients.
Even if patients disagree with these charges, unless they can negotiate a lower amount with the health care provider, they are responsible for paying the bill. Sometimes patients aren’t familiar with their copays. Depending on the insurance plan, copays can vary depending on the type of service used; for instance, payments often differ when you have a preventative medical exam in your doctor’s office versus going to the emergency room after you tumble off a ladder.
Many emergency room doctors–and even ambulance services–are private contractors who might not be covered by a patient’s insurance plan. When a patient receives care from an out-of-network physician, even if it’s at an in-network facility, the patient may be charged for the out-of-network fees.
When patients apply for financial assistance through the hospital, they may believe their bills will be taken care of completely. However, the hospital’s financial assistance policy only covers the hospital’s bill—not those of the emergency room physician, the radiologist, the anesthesiologist or other providers that gave medically necessary care in the hospital.
Hospitals must list which providers delivering emergency or medically necessary care are covered by financial assistance and which are not. Here are some helpful questions you can ask the patient:
“What does your explanation of benefits tell you is owed?”
“Why do you feel you are not responsible? Tell me what happened.”
Many consumers feel by carrying insurance, they’ve fulfilled their financial obligation to the medical provider. But insurance doesn’t relieve patient responsibility. The terms of a patient’s insurance policy will differ between insurance companies. The bottom line: the patient is responsible to pay for services not covered by insurance.