Editorial: No more surprises

Friday, Dec. 14, 2007 | 7:25 a.m.

Even when patients follow their insurance policies to the letter, they can end up with thousands in unexpected medical costs because some practitioners who assist in initial procedures or follow-up treatments are not among those on the insurance policy's provider list.

As a result, the Las Vegas Sun reported this week, a state advisory board is trying to decide whether there is some way to protect patients from being blindsided by huge medical bills and to make sure they are informed about whether their insurance covers the additional physicians or services.

Helen Foley, spokeswoman for PacifiCare/United Insurance and a member of the advisory committee that is working with the state Insurance Division, told Sun reporter Cy Ryan that one solution could be to create an education program that would alert patients, doctors and other medical professionals to the problem that can emerge when experts from outside the coverage network are used.

But Julie Cardinalli, a consumer representative on the advisory panel, told the Sun that an education program doesn't offer patients enough protection. She cited the example of a patient discovering, just hours before surgery, that his insurance doesn't cover the anesthesiologist who is to be used. At that point, finding an anesthesiologist who is covered isn't realistic.

Certainly, a comprehensive education program could be a start. But it does not offer the kind of comprehensive solution this complicated problem needs.

People who pay for health insurance coverage are right to expect they will get the coverage outlined in their policies when they choose doctors within their networks. They also should know when professionals outside that network are going to be needed and, where possible, should have the option of choosing someone whose services are covered.

Engaging insurers, medical professionals and patient advocates in the discussion is a good start. They have the expertise needed to resolve this problem satisfactorily in the interest of patients and without waiting until 2009 for the Legislature to step in.