As a nurse practitioner who worked in primary care, I was educated to take note when a patient was experiencing serious cardiac symptoms, such as chest pain or tightness, shortness of breath, and dizziness.
In the past, one of the patients that I saw in my routine practice was experiencing concerning symptoms such as these, so our medical team was immediately worried about the possibility of a heart attack. We told the patient that he needed to be seen urgently in the Emergency Room, but, to our surprise, he initially refused.
It turned out that, in a previous visit to the emergency room, my patient had received a $10,000 bill, and the stress, fear, and financial devastation caused by that experience meant he was extremely hesitant to go to the Emergency Room again despite the seriousness of his symptoms. He had spent countless hours on the phone trying to figure out why he had received such an expensive bill, and he eventually found out that the physician who had seen him in the Emergency Department was out of network for his health plan, a situation over which he had no control.
The type of bill that my patient had received is called a surprise medical bill, and it was clear that this bill had made him distrustful of the medical system and ultimately, willing to put his health and even his life at risk to avoid another one.
Thankfully, he eventually agreed to go to the Emergency Room, where he was treated for his cardiac symptoms, but I was worried that things could have gone very differently had we not been able to talk him into it.
Surprise medical bills like the one my patient received are not rare occurrences. Nearly 1 in 3 Pennsylvanians are hit with surprise medical bills in a year.
These bills arise when patients are unexpectedly treated by a provider who is not in their insurer’s network. This often happens when a patient has an emergency and must seek treatment at an out-of-network facility. It can also occur at an in-network hospital when some of the providers who care for a patient are not in the network or when an in-network provider refers a patient to get lab work, a diagnostic test, or other care that is not in the network.
Importantly, a surprise bill is not the fault of a patient, but rather is the result of contracting decisions between insurers and doctors or other healthcare providers. Most patients – who may be facing a medical emergency, illness, or injury or may even be unconscious at the time they received the care — are in no position to figure out whether every single provider they may encounter is in-network.
As a retired nurse practitioner, I’m very worried that surprise medical bills are causing people to avoid necessary care or to wait until it’s too late to get the care they need. The data backs this up. A recent study of Pennsylvania adults showed that people who reported facing cost barriers to getting care chose to delay care (29 percent), avoid getting care altogether (21 percent), or skip a test or treatment (24 percent). Moreover, cost was by far the most frequently cited reason for not getting needed medical care, exceeding a host of other barriers like transportation, difficulty getting an appointment, lack of childcare and other reasons.
There is, however, relief on the horizon for patients from these common and unfair bills. House Bill 1862, the Surprise Balance Billing Protection Act, was voted unanimously out of committee and is awaiting action on the House floor. It is a bipartisan compromise that protects patients such as mine from surprise medical bills while paying providers fairly, maintaining patients’ access to their doctors, and controlling premiums and out-of-pocket costs.
Patients and their families simply can’t wait any longer for relief from these unfair surprise medical bills. House Bill 1862 protect patients while establishing a fair and transparent process for paying providers and not increasing costs of health coverage. Lawmakers should move quickly to pass this bill so patients can start getting the care they need without worrying about unexpected bills.
Karen Anne Wolf is a Registered Nurse. She lives in Lewisburg.