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.
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
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
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.