Last month, I started a series on affordability with an article entitled “The ACA’s Role in Creating Equity in Our Health Care System.” I started out the series by sharing my own story about going to the doctor for free preventive exams and leaving with bills that I did not expect. This month, I want to talk more about the growing problem of going to a hospital that’s in your insurance company’s “network” of providers (doctors and hospitals) and coming out with bills from a provider who is not in your network.

Two recent articles detail the issue. The first, from the Atlantic, is entitled “Don’t Pay that Medical Bill,” which discusses balance billing, “the term for a situation in which an entire hospital stay or procedure is covered by insurance, but one of the specialists involved is out-of-network and bills the patient separately.” In this article, a woman shared her story about her husband’s emergency surgery. She asked their hospitals and doctors if they would accept her insurance and was told they would. However, she then received $32,000 in medical bills from the surgeon who operated on her husband. Because of her persistence – and a new law in New York protecting against balance billing – she was able to have these bills covered. The insurance company paid this bill and the provider had to accept much less. Ohio, like many other states, does not have such a law. However, passing similar legislation could be the answer to many balance or “surprise” billing issues in Ohio.

The second article I wish to discuss is by Kathleen Gmeiner in this month’s newsletter, entitled “ODI Moves Forward with Provider Network Disclosure Amid Calls to Do More.” This article, like the first one, provides a story of a person affected by this issue. Wendy McVicker of Athens, Ohio was life-flighted to a nearby hospital, only to find out that the air ambulance service was not totally covered by her insurance provider. Her insurance company paid only $10,000 of the $25,000 cost of the ambulance. The article discusses a new Ohio rule that is being finalized, Rule 3901-8-16. This new rule will require insurance companies to regularly update their network lists, make them more available to those enrolled in their plans and prospective enrollees, and provide information about the cost of out-of-network services. The Ohio Department of Insurance expects the rule to be generally effective 1/1/16, but a few provisions will not go into effect until the following year. The rule would give consumers like you and me more information about the cost of treatment at the beginning of the process of seeking treatment and finding a provider. But the new Ohio rule doesn’t go far enough. Ohio consumers need a law like the one passed in New York.

This is why UHCAN Ohio exists. Our role is to find out what is happening to consumers like you and me, research legislation across the country that addresses the issues we are seeing, and engage you in our efforts to change policies, rules, and legislation to help the health care system work better for you. We do this in many ways including writing policies, analyzing policies, educating legislators on the impact of emerging and existing legislation, and engaging consumers in advocacy actions. Watch for more information on how you can help us advocate for a law like New York’s. 

Nita Carter