It happened so fast, a moment of play turned to blood and panic. Just before lunch 7-year-old Ava was on the floor with the family’s German shepherd. Pettit held out a pizza roll, but the dog lunged just as his daughter popped it in her mouth. Two holes opened in the little girl’s face where the dog’s teeth had been and she started to scream.
Pettit doesn’t remember the five-minute drive from his house in Webster to Clear Lake Regional Medical Center or the sprint through the emergency room doors. He wasn’t wearing a shirt or shoes, his chest turning red from where he pressed Ava’s torn face against his body.RELATED: Surprise bills in store for many Texas ER patients
He fished out his Aetna card. “I’m at a hospital that is in my network. Everyone who’s in this building should be in my network,” he thought. He and his wife had picked that hospital because of their coverage. “It didn’t occur to me it could be any different.”
Then the bills from out-of-network doctors began to roll in.
Pettit, like so many others in this country, had tumbled unsuspecting into a multimillion-dollar business practice called balance billing. The murky system allows doctors outside a patient’s coverage network to set higher rates and then shift any or all of the “balance” not paid by insurers onto patients to make up the difference.
It happens most often in emergency care where vulnerable patients have no way of knowing in advance who will treat them. Often they find out too late that just because the hospital is in-network does not mean the doctor will be, too.
Emerging evidence suggests it may be no accident.
“It’s a system totally rigged against patients. They can’t win,” said Stacey Pogue, a health policy analyst for the Austin-based Center for Public Policy Priorities who has been studying the problem for a decade.
WHO’S TO BLAME? Patients who do all the right things to go to an in-network hospital can still get stuck with thousands of dollars of surprise medical bills because the doctor treating them is out of network.
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