A patient has done her homework and knows a certain hospital is in-network for her insurance, so she chooses that hospital for treatment. At the end of her stay, however, she is presented with a huge bill because certain doctors that work in that hospital are considered out of network. The patient may not even see the out of network doctor or know she is going out of network. If an X-Ray is sent to an out of network radiologist, that could be billed separately. Think this scenario is rare? Think again.
According to the New York Times, these situation may skyrocket under the Affordable Care Act (a.k.a. Obamacare) because, while the law caps the amount a patient must pay out of pocket to in-network providers, it does not limit out of network payments. Out of network providers can bill the patient directly for any costs not covered by her insurance, and those costs can be gigantic. A patient’s only option may be to go to a hospital in which all of the doctors work exclusively for that hospital. In an emergency, however, that is likely the last thing to cross a patient’s mind.
