In the works: How to avoid ‘surprise’ medical bills

Tuesday, Dec. 11, 2007 | 7:06 a.m.

CARSON CITY - A patient entering a hospital for surgery may follow the directions of his insurance company perfectly - and still end up with a huge bill.

Even if individuals choose a hospital and a surgeon on the insurance company's approved list, which should entitle them to coverage of 80 percent of the cost, when they return home they could find something that will make them sick - invoices for thousands of dollars in other medical bills.

"It's like a shock," said Van Mouradian, a supervisor in the health and life section of the state Insurance Division.

A state advisory committee agreed Monday that patients need greater protection from such unanticipated bills.

It's the services not covered by insurance companies that hit the unsuspecting patient. For instance, another doctor in the same company as the primary surgeon, but who is not on the insurance company's list, may treat the patient after the operation, generating an additional expense.

"It's discouraging to the patient to have full insurance coverage and then receive a large bill," said Helen Foley, representing PacifiCare/United Insurance.

She suggested creation of an education program to alert patients, doctors and others to the problem.

"Let the patient know so they don't have unanticipated bills," said Foley, a member of the insurance commissioner's advisory committee on health care and insurance.

Doctors, she stressed, "should be paid for their services." But everyone from patient to doctor will be happier if the extra costs do not come as a surprise.

Julie Cardinalli, a consumer representative on the committee, said that plan won't work. Noting that patients usually do not see an anesthesiologist until the night before surgery, she suggested it is unrealistic to expect a patient, hours before an operation, to locate another anesthesiologist if he learns his scheduled one is not covered on his insurance plan.

"It's not a good solution using an education program," Cardinalli said. "The consumer needs to be protected a little bit more."

Valarie Rosalin, director of the state Office of Consumer Health Assistance, said her agency has received 67 such cases. The agency tries to work out a settlement, possibly through a payment plan or a reduced bill, Rosalin said. Her office tells doctors it may cost more to go through legal channels to collect the money than to discount the charge, she added.

Mouradian said although official complaints to the state agency may not numerous, the additional bills are "significant to the patient."

The advisory committee agreed the matter should be worked out among the parties rather than go before the Legislature for action.

State Insurance Commissioner Alice Molasky-Arman is expected to make a decision on how best to do that at the commission's next meeting. The date for that meeting has not been set.