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News10NBC investigates: 1 in 6 ER patients get a surprise medical bill

July 03, 2019 06:24 PM

NEW YORK (WHEC) -- After our first investigation into double copays, News10NBC learned about a plan to stop surprise medical billing. 

News10NBC Chief Investigative Reporter Berkeley Brean: "Surprise medical bill. What do you mean by that?"

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Rep. Joe Morelle, (D) 25th Congressional District: "So it's when you go in for a medical procedure that is scheduled, and the hospital is in network, the surgeon is in network, but the anesthesiologist, for instance, might not be. And you get a surprise bill when you assume it was entirely covered."

Brean: "What kind of money are we talking about with these bills?"

Rep. Morelle: "Oh it can be in the tens of thousands of dollars. Certainly in the thousands of dollars."

Congressman Morelle is sponsoring a federal bill to end surprise medical billing. It would hold the patient who gets a surprise medical bill harmless and force the insurance company and hospital or doctor to negotiate a price. If they can't figure it out themselves, the law says they go to an arbitrator. 

Rep. Morelle: "And we do what is called baseball-style arbitration. The insurer and provider submit to an arbitrator their best proposal and the arbitrator has to chose one or the other."

News10NBC obtained a release from the congressman's office. 

Here are some of the numbers: 

- One in six emergency room visits result in an unexpected medical bill.
- One in seven in-network hospital stays end with a surprise medical bill. 
- At the same time, out of pocket costs, like high deductibles, have gone up 30 percent since 2015. 
- Seventy percent of patients fail to pay off their entire bill. 

Ron Walker, two copays for one procedure: "It wouldn't be bad if the explanations made sense."

Our investigation into medical billing started last week with Ron Walker in Canandaigua. 

He contacted News10NBC after he got multiple bills for one ultrasound.

Walker: "My frustration is going to the doctor. Paying my copay and getting home and two or three weeks later, I get another bill in the mail for the same visit for another copay."

Morelle's staff told News10NBC about his federal bill after our story with Ron Walker. New York already has a law to stop surprise billing and it was Morelle who wrote it when he was in the Assembly. 

But the New York State Health Foundation says there's a major gap the state law. 

Laura Eldon, program officer NYS Health Foundation: "The state law doesn't have jurisdiction over self-funded health plans."

Brean: "When you say self-funded, you're talking about major organizations like the University of Rochester and other organizations that big?"

Eldon: "That's correct."

Rep. Morelle told News10NBC the federal bill would cover the gap in New York state. 

We contacted the major hospitals in town. In an email, UR Medicine spokesman Chip Partner wrote, "URMC agrees with Congressman Morelle that patients should be protected from surprise bills. We thank him for his leadership on this issue and look forward to working with him."

Here are phone numbers and websites you can use to help understand your medical bill and get help if you're having trouble paying it: 

  • For an advance cost estimate: Call 585.758.7801 or email URMCPriceEstimation@urmc.rochester.edu. Patients will need to describe the service they are seeking, or obtain a "CPT code" (Current Procedural Terminology) from a member of their health care team. They will also need the name of their insurance plan and subscriber ID, which allows our experts to provide a custom price estimate based on their plan's terms and deductible status.
  • For billing information: Type "URMC bill pay" in a web browser, or visit this address -- https://www.urmc.rochester.edu/patients-families/bill-pay.aspx -- for sample bills, insurance plan information, frequently asked questions, contact information and more.
  • For questions after receiving a bill: Call 585.758.7650 or 888.925.4301 to speak with a billing specialist, or email a specialist through our billing website.
  • If patients are unable to pay a bill: Apply for financial assistance online, through a tab on the bill pay web site, or call for financial assistance at 585.784.8889.

Credits

Berkeley Brean

Copyright 2019 - WHEC-TV, LLC A Hubbard Broadcasting Company

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