Tennessee residents who have health insurance may be familiar with the concept of “in-network providers.” If a doctor, hospital, or medical office is in-network, then that provider has a contractual relationship with the patient’s insurance carrier. Insurance companies often prefer their customers to see in-network providers because it makes assessing insurance coverage and payments more streamlined.
However, in cases of emergencies, individuals may find themselves receiving treatment from out-of-network medical providers. If a person sees an out-of-network provider, then their insurer may not cover any or all of their medical bills. This can leave patients with incredible medical expenses that can quickly become medical debt if they cannot pay it off.
For example, a young father suffered a massive heart attack in his home and was rushed to a hospital. It turned out that the facility where he was taken was not in his insurer’s network, and the man even asked while in the hospital if his care would be covered. He was told that the hospital would accept his insurance, but when he received his medical bills, he found that only about one-third of his costs were paid for by his insurer. He was left with more than $100,000 to pay out of pocket.
The man fought the charges sent to him, but his story is unfortunately not unique. Many individuals face this same problem when emergency care forces them to use providers that may or may not accept the insurance they have. When an out-of-network charge hits, the victim of a medical emergency may be victimized a second time by overwhelming medical debt.