Insured Woman Gets $18K Bill for Using an In-Network Doctor

“I’ve always paid my bills. I had excellent credit.”

That’s Nancy Gomez speaking with CBS Los Angeles about her ordeal. She’s a Californian with PPO insurance — and thousands of dollars in medical debt.

Though Gomez is fully insured, she says she received an $18,000 bill for a treatment with an Encino pain specialist in her network, CBS reports. Gomez, who went in for an epidural nerve block, received the bill a few weeks later.

Despite its shocking price tag, the bill was perfectly legal, CBS reports. Though the doctor was in-network during her initial visit, when Gomez went back to get the injection she was directed to a surgical suite, which took the physician out-of-network, the station said.

Also legal: The $9,000 bill she received for a surgery after the epidural didn’t work. Gomez says she checked that the hospital and surgeon were in her network. But an assistant surgeon and anesthesiologist who helped with the procedure did not belong to her in-network provider list.

Now Gomez is shouldering “incredible debt,” she says. And she isn’t alone.

According to CBS, one in four Americans have been hit with medical bills from out-of-network providers who offered care without disclosing their fees.

What You Can Do

It’s important to know what you’re liable for long before the bill is in your hands. That means understanding the difference between terms like “in-network” and “out-of-network” on your insurer’s website and in your plan description, says FAIRHealthConsumer.org, a consumer site dedicated to sharing information about healthcare prices. That also means knowing which specialists, hospitals, labs, radiology facilities and more may fall under your “network” umbrella.

While many plans cover “out-of-network” care, chances are if you go out-of-network, you’ll end up paying more, says FAIR Health. Therefore, the onus is on you to find out whether providers outside your network may charge more and whether your plan may require higher co-pays, deductibles and co-insurance for this type of care. If your plan doesn’t cover out-of-network care at all, you may be left holding the money bag.

Remember, medical debt isn’t unheard of but does require research and action. If you fail to pay what you owe, your bill could could wind up in collections, which in turn can leave a negative mark on your credit report. The last thing you want to do is to lower your credit score at this uncertain time. If medical debt is weighing you down, you can see how it’s impacting your finances by pulling your credit reports for free each year at AnnualCreditReport.com and signing up for a free credit report summary on Credit.com. Working to pay the debt off? Try this handy lifetime cost of debt calculator to see how long it will take.

Image: Dutko