Kane In Your Corner: Surprise medical bills

Posted: Updated:
EDISON -

Tens of thousands of New Jersey families are still getting hit with surprise, out-of-network medical bills, despite a state law aimed at ending the practice. The law, while considered among the strongest in the country, does not apply to most residents who get insurance through their employers.

Kelly Kantor's story is typical of patients who get hit with surprise, out-of-network bills. Her son, Hudson, was born six weeks premature and spent weeks in the Neonatal Intensive Care Unit at Monmouth Medical Center. Both the hospital and her doctor were in-network, but the NICU doctors were not. She was left with a bill of nearly $20,000.

Listen here: Walt Kane talks to Kelly Kantor about her story and a patient advocate about how to protect yourself in a Kane In Your Corner companion podcast for News 12 Talks New Jersey

"You wouldn't think to ask 'Oh wait! Don't touch my son! Are you in network'?" Kantor says. "Why are you working in a hospital that's in-network for me, but you're not in-network?"

A recent study by the University of Chicago found 57% of Americans have been hit with at least one surprise medical bill. It often happens as it did with the Kantors. Their son's neonatal doctors worked for Pediatrix Medical Group, which has contracts with hospitals across the country, often billing on an out-of-network basis.

RELATED: Kane In Your Corner: Protecting yourself from surprise medical bills 

Jennifer Gutierrez, a spokesperson for Pediatrix says "Our team begins working with the patient prior to discharge... to achieve appropriate reimbursement from their insurance company while making every effort to hold the patient harmless."

But the company has gotten mixed reviews. Dozens of former patients have complained to the Better Business Bureau, with many saying they received surprise bills. Despite that, the BBB gives Pediatrix a rating of A-plus.

The situation in New Jersey has been made even more confusing by the state legislature's passage last year of the "Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act." The law requires out-of-network providers who treat patients in an urgent-care situation to bill no more than what they would be responsible for paying in-network providers.

The law does not protect everyone, however. Most people who receive health benefits through their employers are in self-funded plans, which are governed by federal law.

Congress is now looking to settle the issue once and for all. Sen. Bill Cassidy has introduced legislation at the federal level that he says would eliminate surprise out-of-network bills nationwide. Cassidy, a physician, says "Surprise medical billing is not a Republican or Democrat issue, it's a patient issue."

Kantor recently received some good news. Since Kane In Your Corner began investigating the issue, her insurance company has reopened her case and agreed to pay most of her outstanding bill.

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