Kane In Your Corner: Protecting yourself from surprise medical bills

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EDISON -

Legislation passed last year in New Jersey protects less than half of insured patients from getting hit with large, surprise, out-of-network medical bills, and patient advocates say until the problem is addressed at the federal level, patients need to be proactive to protect themselves.

“They should be talking to people before they are consuming health care,” says AnnMarie McIlwain, who advocates for patients on billing and other issues. “That can be an advocate. That can be their insurance company. That can be their doctor. That can be the hospital billing department. There is no cost to asking questions.”

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

Kelly Kantor and Lisa Waterman both told Kane In Your Corner how they got hit with large surprise bills, despite giving birth at in-network hospitals with in-network obstetricians. In both cases, complications resulted in out-of-network specialists being called in. Kantor wound up owing more than $18,000.

Legislation signed by Gov. Phil Murphy a year ago was intended to eliminate surprise medical billing when patients lacked the freedom to choose their own providers. The law requires out-of-network doctors in those situations to bill patients for no more than they would pay in-network.

RELATED: Kane In Your Corner: Surprise medical bills 

But the law protects fewer than half of New Jersey residents who get insurance through their employers. Those in fully insured plans are protected by law. Those in self-insured plans – the more common option – are not. Those plans are regulated by the federal government. McIlwain says most of her patients had no idea what kind of plan their employers offered until they found out the hard way.

Advocates advise people who get insurance through their employers to find out the details of their plan. And once they determine which hospitals are in-network, they suggest patients find out about on-call specialists, such as cardiologists, who practice there.

“If I'm having a baby, is the NICU in network?” McIlwain says. “Always plan for the worst.”

If you’re told services will be in-network, advocates say to get that in writing when possible. At the very least, document names, dates and times. They also advise patients to appeal denials from their insurance provider, and to negotiate with out-of-network providers to get a lower price, if necessary.

There is good news for Kelly Kantor. After Kane In Your Corner started asking questions about her situation, her insurance company ponied up a lot more money. “They've re-evaluated my case and they are paying almost $13,000 out of the $18,000,” Kantor says. “I just really want to thank you for calling them because the second you did, they started paying out. And I am so grateful.”

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