A practice called "balance billing" has patients with full medical coverage paying exorbitant out-of-pocket costs, according to a report in the Atlanta Journal Constitution. It's a controversial and sometimes illegal practice that occurs when a patient's health plan pays less than what the doctor or institution wants to be paid, and it has healthcare providers going after patients for money they may not even owe.
Say, for example, a young man with full medical coverage is involved in a car accident and has to be airlifted to a hospital five minutes away. He recovers, but his pocket takes a decided hit when he opens his mail to find a $20,000 bill for the helicopter ride, and his insurer only pays $8,000 - a price they find much more reasonable. Georgia State Rep. Rusty Kidd found himself in a similar situation last year when he was being carried in his wheelchair down a flight of steps and one of the steps suddenly broke. A broken neck required he be transported to an Atlanta-area facility by air ambulance.
Although the bill was $27,000, his insurer would only pay a fraction of the cost, leaving Kidd to cover the rest. "Without a set contract, insurers often pay only what they determine is a reasonable price for the service," writes AJC reporter Carrie Teegardin. The real problem often arises when patients who are part of H.M.O.'s, P.P.O.'s and other network health care plans choose to use an out-of-network provider. In emergency situations like Kidd's, the patient may not even have any choice in the matter.