VOLUSIA COUNTY, Fla. – A Volusia County woman says an emergency medical procedure is costing her thousands of dollars out of pocket, even though she has insurance and she’s not alone.
It’s called “surprise medical billing” and it’s estimated that one in five emergency room visits will trigger a surprise bill.
Patti McMahon had chest pains that eventually lead her to an Urgent Care in Deland. The news wasn’t good.
She was told she needed double bypass surgery, immediately, according to McMahon.
“It scared me to death,” she said. “I started crying and I cried until the surgery was over.”
McMahon said the surgery at AdventHealth in Daytona Beach was successful, but months later the bill she got nearly made her heart stop.
“It’s frightening and I was very disappointed that I had to go through this through no fault of my own,” she said.
Here’s how it happened.
AdventHealth is within her insurer’s network, so the bulk of the surgery was covered.
According to her insurer, the anesthesiologist and the nurse anesthetist who were on duty the day of the surgery were out of network and not covered.
Their fees were more than $10,000, according to a bill McMahon shared with News 6.
“I had no clue. No way of knowing and no time to check it out,” McMahon said.
The surgery was considered an emergency surgery.
“I had no idea even who the surgeon was going to be until the morning of the surgery,” she said.
Susan McPhail-Taylor is the founder of RN Patient Advocates of Central Florida.
She spent more than 40 years as an registered nurse and administrator, and now helps patients understand their medical bills.
“1 in 5 visits to the ER, that’s like 20%, have some kind of surprise billing on them,” McPhail Taylor said.
It’s been a problem for years, costing American’s millions, but a solution is on the way.
In December 2020 when Congress passed legislation for COVID-19 economic relief, the bill also contained the “No Surprises Act,” which is aimed at protecting patients from surprise medical bills.
One of the key components of the bill holds patients harmless from surprise medical bills, by ensuring they are only responsible for their in-network cost-sharing amounts, in both emergency situations and certain non-emergency situations where patients do not have the ability to choose an in-network provider.
That alone would have protected McMahon. The bad news is the law doesn’t take effect until January 2022.
“Hopefully those surprise bills won’t come in the mail. But if they do, there will be some legislation behind it to resolve things,” McPhail-Taylor said.
In the meantime, it leaves people like McMahon fighting surprise bills on their own.
“It’s scary to me. It’s very scary. I feel sorry for anybody that has to go through it,” McMahon said
A spokesperson from AdventHealth sent News 6 this statement:
“AdventHealth is committed to consumer-centric care, and that includes a payment process that is easy to understand and transparent. We supported the No Surprises Act and we are pleased it will offer a solution to the issue of surprise billing. We remain committed to working with our patients to ensure they understand the cost of their care, and effort to reach solutions when billing issues arise.”