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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Reid Rupp, 21, right, looks over a pile of medical bills with his mother Lisa Rupp. Rupp was riding his bike to class at Miami University when he suffered a severe bicycle accident that required emergency facial reconstructive surgery for a broken jaw and facial bones. The plastic surgeon that performed the work was not in network with the hospital and Rupp is now stuck with more than $17,000 owed to the surgeon. TY GREENLEES / STAFF