How to Avoid Going Bankrupt due to Surprise Medical Charges

It is not uncommon to occasionally hear horror stories involving healthcare costs and bankruptcy. A good many of these stories involve exorbitant medical bills patients are forced to pay after receiving a surgical procedure – charges they did not know about before the procedure, and over which they have no control of afterwards.

Formerly, it was mainly uninsured patients who ended up in this monumental debt trap with unpaid medical bills, typically because they needed an unexpected surgical treatment that included emergency and trauma care. Cancer patients were another group commonly affected by this tragic situation. According to a 2013 CBS news report, people with cancer were more than 2.5 times as likely to declare bankruptcy than people without cancer. [1] However, unexpected medical charges are no longer only affecting the uninsured and cancer patients.

In 2014, a news story broke of a 37-year-old New York resident who underwent neck surgery to treat several herniated discs. After the surgery was completed the bills began to roll in. The amounts on the medical bills he received were high, but expected, and covered by his insurance. What the patient did not expect was a $117,000 bill from an assistant surgeon the patient had never met, never agreed to or even been notified that this physician would be involved in his surgery. [2]

Unfortunately this practice of medical providers calling in doctors, assistants or consultants to help with a surgery without the patient’s knowledge is becoming increasingly common. The charges for these specialists can be very high, particularly when they involve out-of-network providers who can bill 20-40 times the usual rate – as a matter of fact, there is no limit on how much out-of-network doctors can bill. [3] Leaving the ethical questions regarding this practice aside, the fact is that the patient has virtually no say with regards to these practices once he is on the operating table under anesthesia. Whatever explanation the medical provider may give the patient afterwards, once the surgery has been done the bill is not going to go away. Very often, insurers agree to pay these unexpected medical costs at out-of-network rates which only encourages this fairly unethical practice, and ultimately drives insurance premiums through the roof.

This situation and it’s many difficulties makes it practically impossible for a patient or self-funded employer to shop around, bargain or even forecast what the cost will be for a given medical procedure. To deal with this problem, entrepreneurial firms like BridgeHealth have developed techniques to pre-negotiate bundled prices of medical treatments for their plan members, so that patients and their employers can know exactly how much a surgery is going to cost in advance – no surprises and no out-of-network unexpected charges. Pre-negotiated bundled pricing gives patients and their employers the power to predict and control healthcare costs by eliminating unanticipated costs.

Of course, there is more to choosing healthcare providers than cost alone. To maintain the highest quality of medical care, all surgical procedures for BridgeHealth plan members are performed by select medical providers within BridgeHealth’s High Performance Surgery Network. To enter this exclusive network, all hospitals must rank among the top 25% in the country.

Most people are aware that there is something wrong with Healthcare in the United States, and it would be nice to think that a person could undergo a medical procedure without facing bankruptcy or risking their life by sacrificing quality for cost. Luckily, now you don’t have to.

1) Cancer Patients More Than Twice as Likely to Go Bankrupt, Study Shows; CBS News, http://www.cbsnews.com/news/cancer-patients-more-than-twice-as-likely-to-go-bankrupt-study-shows/
2) After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know; The New York Times, http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0
3) Unexpected Medical Bills Lead to Hefty Surprise Costs for Many Patients; KGW.com, http://www.kgw.com/story/news/health/2015/10/26/unexpected-medical-bills-lead-hefty-surprise-costs-many-patients/74648220/

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