When Andrew Heymann helped his friend move two years ago, a glass table shattered and cut open Heymann’s left ankle. An ambulance rushed him to a nearby hospital, which he knew was in-network. But after a plastic surgeon stitched up the wound, Heymann was surprised to receive a bill for nearly $6,000. His insurance initially covered just $860 of the charges.
Heymann learned that although the facility was in-network, the doctor who assisted him was not covered by his insurance. While he was later able to get his employer to cover the remaining charges, others who encounter surprise medical bills are not always so lucky.
Last year, Consumer Reports found 30 percent of Americans with private health insurance have received surprise bills, where their insurance plan paid less than they expected. Of those, 23 percent received a bill from a doctor they didn’t expect to get a bill from. And 14 percent said they were charged higher out-of-network rates by doctors they thought were in-network.
PBS NewsHour gathered personal stories from people across the country who, like Heymann, said they had an experience with surprise medical bills.
NewsHour received hundreds of submissions from people aged 26 to 72, from Boise, Idaho to Chicago, IL. Here are a few of their stories.
Editor’s note: Some responses have been edited for brevity and clarity.
I was approved by my insurance company to have a cervical discectomy fusion last August. I was advised that out of network costs would be paid at 70 percent. I received letters from insurance company listing my surgeon and the hospital specifically as approved. Insurance company denied covering any anesthesia saying anesthesiologist was out of network, and paid only $2,000 of a $28,000 dollar hospital Bill, leaving me on the hook for over $26,000.00 out of pocket. My husband retired last year and we are on a fixed income. This could ruin us financially.
– Kari, 59, Boise
My husband and I were surprised by medical bills when our daughter was born early at 33 weeks due to HELLP syndrome. We went to the ER at our local in-network hospital (where I had been having prenatal visits), were sent to the obstetrics department, and then were transported to a larger in-network hospital, where she was born and stayed in the NICU for 18 days. I stayed for 2 days following her delivery.
The bills started pouring in after we came home — separate bills from the ER, my OBGYN, obstetrics doctors who delivered our baby, neonatal doctors, anesthesiologists, the ambulance company, and the hospitals themselves… approximately over $12,000. Our insurance deductible was $1000. There was no way we could pay them all at once.
– Ashley, 29, Missouri
I went to a 30-day rehab a while back, it was covered completely. When I finished the program the asked me to attend outpatient which again they told me was covered, not even a copay. Years later I have a $40,000 medical bill on my credit report and I have no intention of paying it and no idea how to deal with it. So much for buying a house.
– Michael, 28, New Jersey
I was admitted Jan 2016 to a participating hospital for Pleurisy. I spent 8 days on IV antibiotics until the surgeon insisted that a VATS procedure needed to be performed. During the course of that procedure, the mess that he encountered, both inside and outside my lung, caused him to perform an unscheduled thoracotomy. The surgeon did not participate with my insurance but he was the only surgeon qualified to perform this procedure. I was discharged Feb. 4. I have 2 deductibles to pay and co-payments for each plan. My surgeon’s bill alone was $10,400. It was a life saving procedure.
– Julie Claire, 59, Michigan
We were pregnant with our first baby last year, and we called our insurance co several times to confirm how much our out of pocket max would be. They said $4,000 max, for mom and baby together, assuming normal birth and normal hospital stay of 48 hrs. All of it should be billed to my insurance deducible. We asked again and again to be sure. No other charges should occur, they reassured us. Always got the same answer. So we saved and saved to make $4,000 happen.
After the birth, the hospital billed my newborn’s nursery stay charges during the birth days to HIS insurance, not mine, causing another $1,000 or so in costs to us. I was told by several insurance customer service people that this was an error. We filed several appeals which were denied.
I was livid. It cost us almost a month of my maternity leave that we are funding ourselves. It makes no sense but our hands are tied since the hospital billed it and insurance processed it. It makes me feel even worse for families who don’t check or have no idea what kind of charges they might accrue for welcoming a new baby.
– Leanne, 36, Chicago, IL
We’re asking: Have you been affected by a medical bill you did not expect? Please submit your story using this simple form or share your thoughts in the comment section below.