Consumer Alert: Surprise medical billing. Here’s what to do about it

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ROCHESTER, N.Y. (WHEC) — Today’s consumer alert takes a look at an issue that has likely affected you, and you didn’t even know it. It’s called balance billing. It’s exactly as the name implies.

Let’s say you get a medical service from a provider who is not in your insurance network. Your insurer will send that provider the average fee for that service. But if that provider charges more than what the insurer paid him, he’ll send you a bill for the balance. But in New York, in some cases, balance billing is illegal. And when one savvy consumer got his bill in the mail, he contacted me.

Steve Trobe’s balance billing saga began with a trip to the hospital last winter.

"Middle of the night I got up to go to the bathroom. We think it was ultimately dehydration, but I passed out on the floor on my way back to the bedroom," said Rochester resident, Steve Trobe.

His wife called an ambulance, and Trobe was released from the hospital a short time later.

"But it wasn’t until the bill showed up in the mail that I suspected anything was odd because I wondered why I was getting the bill in the first place," Trobe said.

After all, Trobe assumed the entire bill would be covered by his insurance. Instead, the ambulance service, American Medical Response Inc. or AMR, had charged him $302.16.

"I called my insurance company and asked them what I should do with it and they said AMR is out of network," Trobe said.

So his insurer sent him a check for about $900, the average fee for that service. But AMR charged just over $1,200 for the trip. Trobe then called AMR and was told, "We are going to send you a bill for the balance,” Trobe recalled. “So I said I’m not going to send you the check because that’s the only power I had."

Instead, Trobe called the New York State Attorney General’s Healthcare Bureau helpline. And what he learned shocked him.

"And that’s when they informed me that balance billing in New York State was not legal,” Trobe said.

The AG’s office was referring to the Ambulance Mandate of 2002 which states that “an ambulance service provider cannot bill a patient who has comprehensive health care coverage for the difference between the provider’s charges and the insurer’s payment… " In fact, as New York Attorney General, Andrew Cuomo sued an ambulance company for balance billing New Yorkers.

The AG’s office reached out to AMR on Trobe’s behalf, and ultimately, AMR apologized for the billing writing, "The account has been canceled with collections…” "The consumer is not responsible for further payment." But for Trobe, it was never about the money.

"It’s only $300. That’s not a tremendous amount of money. But how many others were rolled into this and they don’t even know the difference," Trobe said.

My question for AMR is the following: Are they sending all their patients a bill for the balance? A company representative contacted me after my deadline on Monday saying the company is still investigating the matter.

With the help of the NY Attorney General’s office, here’s Deanna’s Do List for medical billing:

  • If you get a surprise medical bill, contact the Attorney General’s Healthcare Bureau helpline at 1-800-428-9071 or contact them online.
  • Carefully review medical bills to see that all charges are proper and that you actually received the services for which you are being billed.
  • Watch for double-billing or unexplained excess charges.
  • Check your prescriptions. Did you receive higher-priced name-brand drugs when generic drugs were available? Ask your doctor.
  • Never sign blank insurance forms. And ask for a detailed bill of your medical services, even if the insurance company is picking up the tab.