As the contractions intensified, she agreed to an epidural to blunt the pain.
Two months later, the anesthesiologist sent her a bill for
Jackson has health insurance with
In the increasingly complex and convoluted world of health insurance, where strapped consumers are opting for high-deductible plans, surprise medical bills like the one from the anesthesiologist have become "far too common," said
Nearly one-third of privately insured Americans received a surprise medical bill in the last two years when their health plan paid less than expected, according to a national survey of 2,200 adults in the
Jackson, 32, works at two nonprofit agencies. Her husband,
"I'm the kind of person who is afraid to go to the dentist because I'm not sure what's covered," Jackson said one recent afternoon as she sat next to her husband in their living room, holding their four-month-old son. "I don't even have a credit card."
Neither Jackson nor her husband could get health coverage through their employers, so they shopped for coverage on the state's online health-care exchange.
They chose the "Neighborhood Secure" plan, which has a high deductible but includes coverage for preventive care at no charge.
"They make it seem like you're shopping on Amazon,'' Nunes said, "but obviously you need a lot more details than if you're shopping on Amazon.''
The plan carries a
He was wrong. Nothing in the Affordable Care Act requires insurers to cover 100 percent of the cost of the birth of a child, said
Jackson's plan with Neighborhood covers childbirth in the same way it would if she were sick or injured and visited a doctor: She has to spend at least
Cheaper plans often carry higher deductibles, which is one reason for the increase in surprise medical bills.
To save money, Jackson chose from Neighborhood's list of in-network doctors. The insurance company's approved in-network providers usually cost a lot less because they have contracts with the insurer to accept certain negotiated rates for their services. Out-of-network providers, on the other hand, have no such agreements. So depending on what the insurer decides to pay an out-of-network provider, patients can be on the hook for part or all of the bill.
Jackson received pre-authorization from
Two weeks before Jackson went into labor, her blood pressure spiked and she was admitted to Lawrence + Memorial for observation. A few hours later, she was discharged. They never received a bill.
(A new federal regulation that takes effect in 2018 would require insurers to notify patients who are pre-approved for surgery or childbirth that they may be billed for out-of-network care.)
In August, the
"We're going to someone in-network, and then we get a bill from the anesthesiologist," Jackson said. "I just don't get it."
Jackson's husband called the anesthesiology company and was told that since the practice was out-of-network, the patient was responsible for the bill.
Since August, Jackson and her husband have pleaded their case to the anesthesiology company, their insurance company and regulatory officials in
"At no time during my pregnancy did anyone at
In mid-September, another bill arrived. This one was from Lawrence +
Together with the
It wasn't. The hospital, too, was out of network. Lawrence + Memorial billed Jackson
In fact, they could have been billed up to five times that amount. That's because the hospital's charges for labor and delivery total
For a planned birth, "it's shocking to me that someone in the system didn't catch that the hospital is going to be out of network,'' said Pogue, the policy analyst. Patients "make some logical assumption if the doctor was in-network, the hospital would be .... Even if you have a really educated, savvy patient, they can't get the answers half the time."
Nunes filed a complaint with the health insurance commissioner's office in the
The insurance company and the hospital say patients need to make sure the health-care providers they see are in their insurer's network -- or be prepared to pay extra.
"There's a shared responsibility from all the stakeholders, including the insured and the providers, to make an informed choice," said
"The hospital's priority is to provide the best care possible, which has happened,'' said O'Farrell. "The end responsibility on the insurance plan and understanding all of the elements of it falls to the patient.''
The following week, the couple received a reduced bill from the anesthesiology company, for
They caught a break -- this time. But the anesthesiologist has the right to balance-bill them for everything
On Twitter: @LynnArditi
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