Insured or not, consumers may face enormous emergency room bills

A blood curdling scream erupts from the backyard. A child has broken her arm.

A wood beam comes crashing down at a construction site. A man was hit in the head and might have a concussion.

Situations like these happen every day. They have happened to us, our loved ones, and strangers. Adrenalin kicks in and our choices become more simple and clear: get help now.

In an emergency, the best help is often the nearest hospital.  When a patient arrives in dire need of care, one of their sources of help may be a physician not covered under his insurance.

Months later this same patient may be blindsided when he receives an enormous emergency room bill in the mail, even though he had health insurance.

“The problem for the consumer is that this is an emergency. They have to have these services and they have no way of knowing what the bill is going to be later,” explained Sen. Pflug, R-Maple Valley, at a Senate Health and Long-term Care committee.

Under the current health insurance system, there are no contracts that would prevent an individual from being additionally billed by nonparticipating providers for emergency room care, even if the services took place at a hospital covered by the consumer's insurance. Because hospitals contract out numerous services to a variety of companies, all with different contracts, this type of billing has become more prevalent.

To protect the consumer, Pflug has proposed Senate Bill 6532 which would prevent this type of medical billing. If passed, individuals who have received emergency room care may not be billed in excess of what they are contracted to pay under their health insurance provider.

Physicians sitting in a row wearing their signature white coats, listened as doctors representing them testified against the bill. Physicians expressed concern that the bill could hinder reimbursement for their services, especially since the current system does not allow for them to easily file claims for underpayment.

“This is definitely a work in progress and a controversial issue for sure. The bottom line is, I believe, that we need to try to move forward,” stated Sen. Pflug.