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When You and Your HMO Don't See Eye to Eye

Sometimes even managed care members are unpleasantly hit with unexpected charges from their health care provider.

WebMD Feature Members of managed care plans often say there's an advantage to paying a fixed monthly premium to cover most of their medical costs. They might shell out the occasional co-payment for a doctor's office visit or prescription medicine, but they generally face no major health care bills beyond the monthly premium (or their share of that premium if their employer pays some of it).

That's the way it's supposed to be, anyway. But sometimes even managed care members are unpleasantly hit with unexpected charges from their health care provider.

A Common Scenario?

You take a nasty turn on a ski slope while on vacation. On the advice of the ski patrol, you check in at the local emergency room to have your knee -- now the size of a small cantaloupe -- examined. You check into your managed care plan's hospital, assuming they'll cover just about everything but the long-distance calls to friends and family. Yet a month later you get the bill, which claims you owe much more than just phone charges. You get billed for services from the emergency room, the doctor and the radiology lab, plus in-hospital lab testing and X-rays that you thought would be covered.

Strategies for Success

What to do? Here's advice from consumer advocates:

Victoria Ross, a counselor at the Health Rights Hotline -- a pilot project in Sacramento, California -- helps consumers navigate their health care plans. Her advice in our hypothetical situation? First, find out if it's a paperwork mistake. If you've been billed for emergency room charges, call up the provider and be sure they have the correct information.