Emergency Room Opportunity to Overcharge

Houston, TXNick was working at his home office when he suddenly felt the left side of his body go numb and a searing pain in his lower back. “Thank God my wife was home. She drove me to the nearest urgent care center but a sign on the door said it was “running at capacity” and couldn’t see any patients that day,” says Nick. “We googled the nearest emergency room—at this point I was almost passing out. And I almost passed out two weeks later when my ER bill came in the mail. I’d heard about ER overcharges but this was ridiculous!”

The “Elite Care 24 hour Emergency Room”, advertised as a “full service ER without the wait” was much closer than the regular ER hospital--Nick believed he was having a heart attack so they didn’t think twice. “The first thing they asked at the front desk was whether I had insurance. My wife gave them our provider’s card and a few minutes later I was whisked into an exam room and saw the doctor,” says Nick. 

The ER doctor ordered blood work and a CT Scan. During the two hours Nick and his wife spent at ER, no one mentioned their insurance was out of network, neither were they told of the charges, nor was he asked to go ahead with the procedure without insurance clarification.

“A few weeks later I got my bill in the mail and almost had another heart attack,” Nick says. There were three CT Scan views with three different charges totaling $21,821.49 and the bill showed ‘out of network’. I called my insurance provider, figuring there had to be some kind of mistake, but I’m on the hook for 90 percent of that bill.“

Turns out that Nick didn’t have a heart attack that –his GP thinks it was a panic attack. And now with this cost looming over his head, Nick is a prime target for another attack. “I feel so depressed, like nobody is on my side,” he adds. “I appealed these charges but Elite Care rejected it and I need to get treatment for my back problem but at what cost? I can’t get any answers from my insurer. So frustrating. My only hope is to get legal help.”

About one-third of Americans learn after the fact that their health plan doesn’t cover nearly what they expected. According to Healthline.com, overdue medical bills account for 59 percent of Americans being contacted by a debt collector and 16 percent of Americans’ credit reports include medical debt –for a total of $81 billion!

“Hospitals and doctors keep sending patients surprise bills because they make money by doing so,” said Charles Silver, endowed chair of civil procedure at University of Texas at Austin School of Law and co-author of “Overcharged: Why Americans Pay Too Much for Health Care.” “They face little risk of losing customers.”