HARI SREENIVASAN, PBS NEWSHOUR WEEKEND ANCHOR: One out of three American adults who have private health insurance coverage nevertheless receive what “Time Magazine” calls a “surprise” medical bill, according to a survey conducted by “Consumer Reports”. The unwelcome surprise is for procedures they think are covered by insurance but are not, ranging from a few hundred dollars for an emergency room visit to tens of thousands of dollars for an operation.
Reporter Haley Sweetland Edwards wrote the story “You Only Think You’re Covered” for this week’s issue of “Time Magazine” and she joins me now from Miami to discuss it.
So, what is the trap that people are getting caught into? You basically break it down to this in-network versus out-of-network chasm.
HALEY SWEETLAND EDWARDS, TIME MAGAZINE REPORTER: Right. So, people will go to an in-network hospital, see an in-network provider, and over the course of that medical visit, interact with other medical providers who are out of network. So, an in-network hospital will contract with out-of-network providers — radiologists, anesthesiologists, lab technicians. All of those people, even though they’re working at an in-network hospital, can be out of network and often are.
HARI SREENIVASAN: There’s no way for a consumer to know when you walk in who is in network. It’s not like they’re wearing different colored uniforms?
HALEY SWEETLAND EDWARDS: Right, right. And even when patients ask ahead of time, they say, you know, “I’m going in for this procedure, is my doctor in network, is my anesthesiologist in network?” They don’t know to ask other questions like, is the consulting surgeon on duty that day who may or may not be in the operating theater, is he also in network?
HARI SREENIVASAN: Now, the Affordable Care Act is supposed to make it, that as you say in the story, if I break my arm and I go the ER, I’m supposed to basically get in-network rates. But that’s not the whole story.
HALEY SWEETLAND EDWARDS: That’s not the whole story. Obamacare does takes us a step in the right direction where they say, you know, if you break your arm and are whisked off to the hospital, the other end of that ambulance ride, no matter where you show up, they have to charge — your insurance company has to charge you as if that facility is in network, which is great. It’s better than it was before.
But it doesn’t protect you from everyone else working at that facility, whether or not they’re in network. So, you can still get hit later with these surprise bills from the providers themselves, from the drug makers, from the device makers.
HARI SREENIVASAN: So, you just rattled off different interests all trying to figure out who gets the bill. So what are states doing to try to fix this or if there’s any federal legislation? What’s happening?
HALEY SWEETLAND EDWARDS: It’s been halting. There are about 10 states that have passed different legislation, attempting to address this problem. California and Florida have transparency measures in place, that patients theoretically are suppose to be told ahead of time whether there will be an out-of-network provider. They are also supposed to protect patients in emergency situations. But it’s really — it’s really stop-and-go.
HARI SREENIVASAN: Reporter Haley Sweetland Edwards joining us from Miami from “Time Magazine” — thanks so much.
HALEY SWEETLAND EDWARDS: Thanks so much for having me.