Surprise out-of-network balance bills occur when a patient receives care from a doctor who 1) is not in the patient’s health plan and 2) was not chosen by the patient to render care. Typically, this happens in the emergency room. The patient presents to an in-network hospital but the specialists on call are out-of-network. It can also happen during elective surgeries (by in-network surgeons) when the anesthesiologist or pathologist is out-of-network.
You have probably seen the news stories.
Typically, the narrative is that these patients are exploited by predatory OON physicians who take advantage of the patient’s lack of choice. Patients get “exorbitant” bills that can bankrupt them. Or the insurance company has to pay and premiums go up for everyone.
The truth is this: almost all doctors charge based on a published guide that lists usual and customary fees. This published guide takes into account the high cost of providing medical services in States such as New Jersey.
However, the insurance companies would rather NOT pay according to this guide. They have discovered that by underpaying medical claims, they can pad their profits. Remember, insurance companies make a profit by collecting your premiums but not paying your medical bills. Or severely underpaying them. This is their business model.
Who gets stuck with the unpaid bill? You do. Hence the “surprise.” You thought you were covered.
You pay high premiums for health insurance so that that you are financially protected at the most vulnerable time in your life – when you need medical care. Now, even if you survive that trip to the ER, you may not survive the nasty medical bill that your insurance company sticks you with.
All in the name of corporate profit.
The Doctor-Patient Alliance has been created to protect New Jersey citizens from predatory insurance companies that charge high premiums but offer only false financial protections when we get sick or injured. Let’s hold the insurance companies accountable to pay their fair share.
Join with us as we fight to protect the rights of patients to choose their doctors in New Jersey. Sign our petition.