Solon resident Jodi Creasap Gee had just relocated to the Cleveland area from Missouri with her husband and three kids when her 5-year-old daughter cut her foot.
The house was still in disarray and the kids were playing when her daughter came into the kitchen screaming, Creasap Gee said.
“There was just a trail of blood behind her. Her foot’s all bloody and I’m going, ‘oh no.' I don’t even know where to go because we just moved here, and it’s a Sunday,” she said.
Creasap Gee checked her insurance company’s website to find a hospital in the insurer’s network. She took her daughter to University Hospitals Bedford Emergency Department.
After covering the $250 co-pay for the stiches her daughter received in the emergency room, she thought that was the end of it.
Then a bill arrived in the mail.
“Even though the hospital itself is in-network, as I found out later the doctors who are there aren't necessarily in-network. And we got this big bill for $910, and I was like, ‘What is this? I thought we had good insurance',” she said.
Going to an in-network hospital does not necesarily mean the providers you see there will be in-network, too, Jodi Creasap Gee and her family learned when they were hit with a massive bill. [Marlene Harris-Taylor / ideastream]
Creasap Gee is not alone in her dismay over what is known as a surprise bill. Surprise bills shoot up when patients are treated at a facility that is covered by their health insurance, but a doctor or other medical professional working there is not inside the patient’s insurance network.
Momentum is building among both federal and state lawmakers to take on this issue. In a recent Kaiser Family Foundation poll, more than half of respondants said protecting people from surprise medical bills should be a top priority for Congress — and it appears lawmakers are listening.
A bipartisan Lower Health Care Costs Act of 2019 is being considered in the U.S. Senate. The bill has a provision that would change the current practice and possibly shift the burden of paying for these bills from patients to insurers.
Ohio lawmakers are also considering adding a provision to the current state budget which would mandate that a hospital inform patients ahead of time if a doctor is out of their network. The budget bill is still being negotiated, and it’s not clear if this surprise bill amendment will be included in the final version.
However, many local hospitals officials say they are already taking steps to keep patients from being saddled with huge surprise bills.
UH officials said patient privacy issues prevent them from discussing Creasap Gee’s specific bill, but the hospital system recently unveiled a new patient financial bill of rights which, when fully in place, would keep future patients from receiving surprise charges, said Kathy LeBrew, UH vice president of revenue cycle.
She said UH is working to bring all the doctors working inside its hospitals inside insurance networks.
“We're not there yet," she said. "We are working toward that."
When asked for a specific date when UH would have all its physicians in-network, LeBrew declined to give one, calling it "a hard question for me to answer."
UH is committed to making sure patients are aware - before a scheduled procedure - that they could get hit later with out of network charges, she said.
Both MetroHealth and Cleveland Clinic officials said they each have a similar policy and they make sure patients are informed before a scheduled procedure if that provider is out-of-network.
But patients in emergency situations like Creasap Gee may still get ER treatment from doctors who are out of their insurance network, especially at satellite locations, off the main campuses of hospitals.
Political pressure from Washington and Columbus may soon push hospitals and insurers to do more.
President Trump recently, publicly declared his support for Congress addressing surprise bills.
These surprise bills are driving consumers crazy, said Douglas O’Brien, the federal Health and Human Services Department's Midwest regional director.
“I know University Hospitals, Cleveland Clinic are getting the message. They understand they have got to produce more consumer-friendly interactions with patients if they are going to survive,” O’Brien said.
It will take time to convert a complex medical payment system that includes hospitals, contracts with doctors groups and numerous insurance companies, said J.B. Silvers, Case Western Reserve University professor of health finance. Hospitals need a shift in thinking and not just treat surprise bills as a financial issue but as a patient relations question, he said.
“If you take it from that point of view then do you want to have, in one of your regional hospitals, a contract with an outside physician?" Silvers said. "Probably not because you know that's going to lead to the problems like the surprise bills."
Change is coming on surprise bills, Silvers said, but other issues, such as bringing down healthcare costs are more complicated and will take time to find the right solutions.
The patient in this story reached out to us via the Bill of the Month, a crowdsourced investigation by Kaiser Health News and NPR. Do you have an interesting medical bill you want to share with us? Tell us about it!