A state report just release has found an alarming number of those with health insurance are getting unexpected medical bills for procedures they believed were covered (see article below).

Just last semester, a GC (CUNY Graduate Center) student had a procedure performed that was supposed to be fully covered by their NYSIP insurance. Having read our advice on avoiding NYSHIP pitfalls, they double-checked beforehand not only that the practice where the procedure would take place was in-network, but also that the doctor performing it and the anesthesiologist were in-network too (never forget the anesthesiologist!); and that all necessary tests or lab-work would be sent to an in-network lab.

But, a few weeks after the procedure, a massive bill—from the anesthesiologist—arrived in the mail.

Thankfully, this student didn’t just pay up; they spoke to the doctor who’d assured them that every aspect of the procedure, and all the medical practitioners involved, would be covered by their insurance. And the doctor waived the bill.

So, make sure that you’re familiar with everything to watch out for when it comes to avoiding charges not covered by your insurance (check out those tips on avoiding NYSHIP pitfalls), and don’t immediately pay any amount that you believe you were billed for in error, until you’ve exhausted all your options.

And, remember—DSC Health & Wellness is here to help you with just such issues! Feel free to contact us if you have this sort of problem, or any other health- or wellness-related issue.

Insurance companies to blame for ‘surprise’ medical bills: state report

Big insurance companies and some greedy doctors are to blame for the growing number of New Yorkers whacked with ”surprise” medical bills, a state inquiry has found.

Department of Financial Services Superintendent Benjamin Lawsky Wednesday released the results of his probe into the unanticipated bills that are slamming consumers.

“Simply put, surprise medical bills are causing some consumers to go broke,” the report states.

The Daily News has highlighted this problem with a series of stories over the last two months. Lawsky promised to push for reforms.

“Every time I have mentioned this issue to a crowd of people, I see nodding heads,” he said. “If that’s happening, it is a huge issue.”

His agency reviewed 2,000 complaints from 2011 and surveyed the 11 big insurers and HMOs who cover 95% of the New Yorkers who have health insurance.

The review found that patients who went out of their way to make sure the non-emergency treatment they sought was covered by their plan still wound up with bills from specialists — such as assistant surgeons, anesthesiologists and radiologists — who were outside their plan.

That’s because insurers often don’t make clear who will be involved and how much it will cost, the report found.

One patient who complained to the Financial Services department made sure to go to an in-network hospital for brain surgery but wound up with a surgeon who wasn’t in his plan. The surgeon billed him $40,091 and the insurer covered only $8,386 – leaving him to cough up $31,704.

Read more, over at the NY Daily News.