(WSVN) - Before she went to the doctor, she asked if they accepted her insurance. They said yes. A few days later, she got a bill for the visit, and then things got worse. That’s when she called Help Me Howard with Patrick Fraser.
Maryanna takes good care of herself: exercise, eating right. But of course, she still gets aches and pains.
Maryanna Healy: “My shoulder has been bothering me. It’s probably just an age thing, rotator cuff.”
She called her primary care office, where she was told a new doctor would see her.
Maryanna Healy: “They told me, ‘Yes, your insurance is going to cover this. Oh, yes.'”
The appointment went well … and then she was hit with a new ache.
Maryanna Healy: “About two weeks later, I get a bill for $548.”
Turns out the doctor she saw had not yet been approved by her insurance. She called the office.
Maryanna Healy: “‘And it’s all going to work out. And we’ll – we will redo it, and it’ll be fine.'”
It wasn’t fine.
Maryanna Healy: “I got another bill, and I’ve been following up, and I keep getting electronic and paper bills.”
Maryanna contacted her insurance company, who told her how her doctor could get approved by them.
Maryanna, who worked in the health care industry for 40 years, says she explained it to the staff members.
Maryanna Healy: “I’m going to say 15 times at least, and the same thing happens. It was like I was Groundhog Day no matter what I did.”
Then she finally she got the painful letter from the doctor’s office.
Maryanna Healy: “Final notice. They’re going to take action against me if I don’t pay this bill.”
She went to the physician to feel better, not worse.
Maryanna Healy: “It just made me angry. I could pay the $548. It’s not about the $548. It’s about justice.”
The pain in her shoulder is going away. Now Maryanna needs a prescription to make her billing headache disappear.
Maryanna Healy: “My husband convinced me. ‘You need to call Help Me Howard.'”
Well, Howard, if a medical provider says they accept your insurance, do you have to pay if they don’t?
Howard Finkelstein, 7News legal expert: “No, you are not responsible. This is simple. Maryanna called the doctor’s office, and she relied on what they said: that they accepted her insurance and were in her network. Therefore, she is not responsible for the bill.”
We contacted the representative for the doctor’s office. We wish every problem could be solved this quickly. That afternoon they contacted Maryanna.
Maryanna Healy: “She said she took care of the billing and would move it over to ‘insurance only.’ And she was apologizing.”
Maryanna went to a doctor’s office. What if it’s a hospital where you see several doctors?
Howard Finkelstein: “There’s a new law, called the No Surprises Act, that says if you go to a hospital that’s in your insurance company’s network, and one of their providers does not accept your insurance, you only have to pay what you would have paid if they accepted your insurance.”
Maryanna doesn’t owe any money at all, after her call to Help Me Howard.
Maryanna Healy: “And I really appreciate what Patrick and you and Howard, everyone has done. It’s remarkable how once the media was involved, the problem could be solved in two hours, and I had spent countless hours on it for the past four months.”
As in many cases, it’s just getting in touch with the right person. That’s why we’re here, to help you do that.
And to know your rights if you get a surprise medical bill, or to know what to expect ahead of time, the links to the state and federal laws protecting you are at the end of this Help Me Howard story.
Got a problem that’s a real pain? Aching to get a solution? Make an appointment with us, ’cause we have the prescription to help you out.
With this Help Me Howard, I’m Patrick Fraser, 7News.
Florida law prohibits surprise billing in emergency situations. In addition, it protects consumers when they are at in-network hospitals for non-emergency services, but are unknowingly treated by out-of-network physicians for covered services. Hospitals must post on their websites the health plans with whom they are in-network, and put consumers on notice that patients may be seen by out of network practitioners.
For more information on Florida’s consumer balance billing protections, please contact the Agency for Health Care Administration, at 1-888-419-3456 / 800-955-8771 Florida Relay Service (TDD number). Additional information for consumers is available on the Florida Health Care Complaint Portal.
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