Titusville mom says she was overcharged for daughter's emergency room visits
Florida Hospital Association confirms balanced billing is illegal
TITUSVILLE, Fla. – A mom in Titusville says she got sticker shock when she received the doctor bills from two of her daughter's emergency room visits.
She says what shocked her even more is that the doctors who treated her daughter were considered out of network, even though the hospital she chose was in network.
Justine Smith says in January, her 7-month old baby Addilyn started having seizures so she rushed her to the emergency room at Parish Medical Center, the closest hospital to her home.
"She had about 20 seizures that night," Smith said. "And we were there quite some time before she was transferred to a pediatric hospital.
Smith says Addilyn was diagnosed with febrile seizures due to having a high temperature.
Two months later she had another episode, and Justine rushed her back to the emergency room at Parish Medical Center.
She says part of the reason she picked Parish was because it was an in network hospital, and she had used it before with absolutely no problems.
"They take our insurance, that's where we delivered both our babies there," Smith said.
But when she started taking a closer look at the insurance claims and doctor bills, she discovered out of network charges totaling more than $2,000.
At first she thought it might have been a simple mistake but she discovered it was not.
"The hospital does not require that their doctors take the same insurance as their facility," Smith said. "When you're in that situation, when your daughter is having a seizure and you have medical personnel working on her, you don't think to ask, 'Are you in my network first?' It's a dishonest policy not to be up front with their patients that not all their doctors take the same insurance."
Natalie Sellers, the vice president of communications at Parish Medical Center, says their ER physicians are required to accept all of the same insurances as the hospital, but Sellars would not answer multiple calls and emails asking what happened in the Smiths' case.
Instead, officials sent their consumer guide to health care prices.
"If there is a question or a concern about a bill received, we welcome and encourage the opportunity to work directly with the patient/parent to resolve (it) promptly," Sellers said.
That's because in 2016, lawmakers drafted and passed House Bill 221, which prohibits an out-of-network provider from balance billing members of a preferred provider organization or an exclusive provider organization for covered emergency services or covered nonemergency services.
The bill established a payment process for insurers to provide reimbursement for such out-of-network services. The bill requires insurers to provide coverage for emergency services without a prior authorization determination, and regardless of whether the provider is a participating provider.
"That shouldn't happen," said Bruce Rueben, the president and CEO of Florida Hospital Association. "If that were to happen, it would be in error - or in conflict with the law."
The Florida Hospital Association is the trade association for more than 200 hospitals and health systems across the state. Its website states the FHA is the voice of Florida's hospital community.
Rueben, who has been the head of the FHA for 10 years, says even though balanced billing is against the law, things can slip through the cracks, especially if you have a high-deductible plan.
"Absolutely, it is possible and does happen," Rueben said. "So it makes sense to pay attention, and it makes sense to ask questions."
Rueben says hospitals cannot restrict a doctor from practicing at their facility just because they don't accept the same insurance.
News 6 contacted nine hospital groups in Central Florida to see if they have out-of-network doctors practicing at in-network emergency rooms.
They include Health First, Steward Health Care (formerly Weusthoff Health System), Florida Hospital, Orlando Health, Central Florida Health Alliance, Nemours Children's Health Systems, HCA Healthcare, St. Cloud Regional Medical Center and Halifax
Here is who responded:
Health First deferred to the law and the comments left by Rueben.
Orlando Health, which represents seven emergency departments, sent this statement:
"There are sometimes cases where a doctor has privileges to practice at a hospital, but isn't an employed hospitalist. That out-of-network doctor can send the 'balanced bill' for an ER visit, but patients don't have to pay it if the hospital is in-network.
"Unfortunately, people who aren't aware of this law and end up paying for it.
"We work closely with our physician groups to make sure that we accept the same insurance."
--Alayna Curry, APR
Manager, Media Relations & Public Affairs Orlando Health
Florida Hospital also acknowledged the law and sent this response.
"We work closely with physician groups that frequently practice in our hospitals to make sure we accept the same insurance. However, there are instances when physicians who are not employed by Florida Hospital practice at our facilities and are out-of-network. If a patient reaches out to us with a concern, we serve as an advocate for our patient and try to resolve the issue with the physician on their behalf." - Florida Hospital
Corporate Communications Florida Hospital
Halifax Health also responded.
"It is possible, it should not happen that often. Most hospitals require hospital based physicians to contract with their high volume plans. Sometimes it happens by mistake, i.e. the contractor, hospital or plan does not properly identify or enroll the physician.
"HB 211 does prohibit balance billing and lays out a process for the provider and plan to follow to resolve payment disputes (applies to PPO and EPO, HMO enrollees are already protected."
Tangela Boyd, MA
Public Relations Specialist
Smith is making sure she does not end up paying the out of network charges but says it hasn't been easy.
"I've been battling back and forth, and that's why I reached out to Channel 6," Smith said. "I would be perfectly happy to pay a doctor bill of a doctor in my network, as I should. But I do not feel that it is fair when you have no control over who sees you or your child in an emergency situation."
Smith says after she contacted News 6, Parish Medical Center did grant a one-time courtesy on two of her emergency room visits, but Addilyn has been to the ER three times.
Smith says she has no idea how she and her husband will pay the thousands of dollars in charges not covered by their insurance plan.
Rueben says if someone has been billed an out-of-network rate for an emergency room visit, they should challenge the amount and make sure there wasn't an error -- and if they don't get results, he recommends they call the Florida Hospital Association Regional office at 850-222-9800.
"Don't feel intimidated or embarrassed or worried about asking questions," Rueben said. "You have every right to understand what you are being billed."
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