When Reid Rupp was rushed to McCullough Hyde Hospital in Oxford last year with a broken jaw and knocked-out teeth from a bicycle accident, he needed to be transferred to a larger hospital.
The 20-year-old Miami University student’s parents, Lisa and Christopher Rupp, were asked to pick whether the ambulance should take him to a hospital in Cincinnati or Miami Valley Hospital in Dayton.
They picked Miami Valley. It was in-network, near their home in Oakwood, and the family had been there before.
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But even though the hospital was in-network — the term used to describe agreements for reduced rates negotiated between providers and insurance companies — the plastic surgeon who operated on Reid Rupp was not. Five weeks later, the Rupps received a medical bill for more than $17,000.
It’s common for hospitals to contract with doctors who are not on staff, and patients aren’t always told they will be billed separately by the doctor. If the doctor and insurance network don’t have an in-network agreement to keep costs down, patients can get stuck fighting a high bill they thought would be covered by their insurance plan.
Hospitals and doctors say it’s difficult to pre-emptively explain what the total patient cost will be, particularly in emergencies. Out-of-network physician groups have also argued that the reimbursement rates they get from insurance companies aren’t adequate for them to join a network plan, leaving them little choice but to pass their costs onto their customers.
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