Picture this: You’re on your way to work when a negligent driver suddenly hits you. When the ambulance arrives, you’re advised to go to the nearest hospital to get checked out. During this time, you’re suffering from injuries, shock, and other thoughts swirling through your mind. Putting your trust in medical professionals, you oblige.
While being seen at the hospital, multiple health care providers go in and out of your room to tend to your needs. After being treated for your injuries, you go home to start your recovery and don’t think twice about the hospital bill because you’re insured and figure you won’t have to dole out a nickel for the care you received because it’s covered.
But that hospital wasn’t in your healthcare network and one of the specialists who treated you doesn’t take your insurance. SURPRISE! You get a big bill through no fault of your own. And now, both the hospital and your insurer are expecting you to pay.
As Dallas personal injury lawyers, we see more and more people who have been left with infuriating, expensive surprise medical bills after an emergency visit to the hospital. Unfortunately, surprise medical bills aren’t that much of a surprise. While hospitals offer vital care to emergency room patients, they’re also focused on maximizing their profits. And hospital billing departments bet—often correctly—that accident victims will not understand or will be too afraid to fight for fair pricing.
In this article, we’ll explain what the law says about surprise medical bills and how to challenge any suspicious medical bill you receive.
What Are Surprise Medical Bills?
If you’re reeling from the shock of an unexpected, jaw-dropping medical bill, you’re not alone. Studies have shown that about 1 in 5 emergency room visits results in a surprise bill.
People get a surprise medical bill when they unknowingly receive medical services—often in an emergency situation where patients are rushed for treatment—outside of their insurer’s networks of hospitals. It can also happen if a patient goes to an in-network hospital and the patient receives treatment from other medical care providers (like anesthesiologists and other specialists) who are out-of-network.
The insurance company won’t agree to pay for these out-of-network hospital charges, leaving you on the hook for the balance. These surprise bills (sometimes called “balance bills”) then arrive in your mailbox with shocking price tags that sometimes run into hundreds or even thousands of dollars.
What Texas Law Says About Surprise Medical Bills
Unfortunately, Texas hospitals have a notorious problem when it comes to surprise medical charges. A recent study showed that several Texas hospitals were among the worst offenders for inflated hospital bills—sometimes charging patients upward of nine times the cost of care.
So many people were on the hook for these unexpectedly huge medical expenses that state lawmakers passed a law in 2020 to protect patients from these surprise medical bills. Senate Bill 1264 protects patients with state-regulated health plans from surprise bills in emergencies and in cases where the consumer had no choice of providers.
Previously, if an insurer declined to pay the full price charged by an out-of-network doctor for a medical procedure, the doctor could bill the patient for the remainder, or balance, of the cost. Now, this recently passed law requires doctors, hospitals, and insurance companies to figure out payment disputes themselves—without ever billing the patient for the balance.
There's a Federal Law That Protects People From Surprise Medical Bills Too
If you’re one of the 40% of Texans with a federally-regulated health plan, you now have some degree of protection, too. A new federal law, known as the No Surprises Act, protects patients from balance bills and surprise medical bills when they get emergency care or are treated by an out-of-network provider at an in-network hospital.
In short, if the medical facility is not willing to cooperate with you or your insurance about your bill, they may be in violation of federal law and Texas Senate Bill 1264.
What to Do If You Receive a Surprise Medical Bill
Unscrupulous health care providers aren’t simply going to write ‘Surprise!’ on top of a now-illegal bill. So, it’s up to you to be on the lookout for suspicious costs. If the final price tag is larger than your normal co-pay or deductible, that should be an immediate red flag that you might have been incorrectly billed.
However, none of this is to say that understanding and disputing a surprise medical bill will be easy.
In addition to focusing on recovering from their injuries, patients hurt in accidents are often forced to track down and decipher their medical bills in order to understand exactly what they’re being charged for—which is why millions of Americans give up trying to fight them. According to a national survey conducted by Consumer Reports, more than one-third of respondents simply paid bills they weren’t sure they owed because they were too confusing to understand. They also worried that not paying would hurt their credit score—which is a real fear when medical providers are threatening to report you to a collection agency.
Fighting a surprise medical bill takes a lot of work, but it’s possible. Here are some steps you can to make sure nobody bills you for more than you expected:
1. Act Quickly
Most bills have a due date. While these deadlines can be extended, challenging a medical bill should be done as soon as possible. Acting fast is especially important for people with federally-regulated insurance plans, as you can only challenge your bill if you file the dispute within 120 days of the billing date.
2. Call Your Insurer
Call your insurer to see if they can validate the bill. If they can’t and tell you that you shouldn’t have received it, call the medical provider and question the charges. If they insist you’re responsible for paying, try to do a three-way call with yourself, your provider, and your insurer to get to the bottom of the charges.
3. Keep Records
Many hospitals, doctors’ offices, and insurance companies will bombard you with paperwork—especially if you decide to dispute a bill. Keep everything they send, and in turn, keep records of every letter or email you send or notes of any phone calls you make.
4. File a Complaint
If both your insurer and the medical provider won’t amend the bill and insist you must pay, file an official complaint. The Texas Department of Insurance outlines several ways you can report surprise medical bills. You can also submit an official complaint to the federal government online or by phone and have them investigate the issue.
5. Don't Pay Anything Until the Issue Is Fixed
While you are waiting for the investigation, you will probably receive calls from collection agencies hounding you to pay. Remain calm and inform them you’re disputing the bill. Most importantly, do not pay anything towards the bill, as that is a sign of accepting responsibility.
6. Get Legal Help
Hospital bills are filled with complex billing codes and specialized terms that aren’t designed for everyday people to understand. Injury lawyers, however, are familiar with medical billing practices and can help you understand those charges.
A Dallas personal injury lawyer can also help you file a claim against the party responsible for your injuries, which will cover your medical fees. Most importantly, hiring an attorney lets the hospitals and insurance companies know you’re serious and will not blindly accept any exorbitant bill they send your way.
How a Dallas Personal Injury Lawyer Can Help Fight Your Medical Bills
A Dallas personal injury lawyer is a valuable ally in any injury case, especially when it comes to fighting medical bills. Injury attorneys understand common techniques medical providers use to inflate hospital bills, including unclear fee structures, unnecessary treatments, and “double billing“. Attorneys also understand tricks insurance companies might use to delay or deny payment and will negotiate on your behalf to get the compensation you deserve.
If you’re hit with a surprise bill, here’s how a Dallas personal injury attorney can help:
- Pressure hospitals to obtain an itemized list of the charges.
- Keep all of your medical bills organized and up-to-date.
- Determine which costs have been inflated or are inaccurate.
- Communicate with insurance providers on your behalf and argue to ensure you receive adequate compensation.
- Negotiate with healthcare providers to reduce the cost of your surprise medical bill.
- File a suit against any healthcare or insurance providers who are acting in bad faith.
Hit With a Surprise Medical Bill? Our Dallas Personal Injury Lawyers Can Help
Don’t let a surprise medical bill interfere with your recovery. At The Law Offices of Tim O’Hare, our Dallas personal injury lawyers will act as your advocate during every step of the healing process—from negotiating with insurance companies who are delaying your compensation to fighting with unscrupulous healthcare billing departments sending you surprise bills. Get in touch with us today for a free, confidential case evaluation and we’ll help you get back on the path to recovery.