A Cincinnati-area woman thought she had prepared for everything when she recently had a new baby boy. But like many hospital patients these days, she was not prepared for a big out of network bill for something she didn't even know about.
Sarah Hayes was expecting a few surprises when she gave birth to her baby. Would it be a boy or girl? What color eyes?
But she did not expect a surprise bill for over $1,000.
The Anderson Township mom discovered that the bill came from a company called Pediatrix, for a service it didn't specify.
"I thought it was a scam, "Hayes said."This is the first time I received a letter that was almost threatening in nature, without almost any kind of explanation."
So she called, where she learned that Pediatrix is the leading provider of newborn hearing screening nationwide, including Cincinnati's Christ Hospital where she delivered.
But Hayes was upset, because she had made sure in advance that her hospital, doctor, and anesthesiologist would all be fully covered.
"I checked to make sure it was going to be in-network. Yes it was in-network," she said.
Complaints about many hospitals, many services
This is not just one hospital and one newborn screening company generating complaints. Patients across the country are finding that while they thought their doctor and hospital were in-network, they found that some part of their procedure was not.
Slate Magazine, in a recent report, calls it "Drive-by- Doctoring," and says it's legal and common, and not just for baby delivery.
The report suggests if you are going into a hospital for a non-emergency procedure, you:
- Ask your doctor and hospital if they use any out-of-network labs.
- Ask questions if they tell you to sign something before an unexpected test.
- Make sure the doctor, anesthesiologist, and anyone else who works on you is in your insurer's network.
Since we got involved, Sunrise, Florida-based Pediatrix has waived Hayes' bill, telling us "the issue has been resolved to the patient's satisfaction."
It also claims her bill was not for newborn hearing screening after all, though it did not specify what the $1,000 bill was actually for. (See company's full statement below).
Meantime, hospital spokesman Bo McMillian told us: "Pediatrix works in tandem with our physicians to provide 24/7 neonatal care. To date, patient and physician feedback has been extremely positive."
The Better Business Bureau gives Pediatrix an A Plus rating for responding to complaints. But the BBB website has more than 70 complaints about unexpected Pediatrix bills from people like Sarah Hyes, who says new moms should not have to fight over an unexpected hearing test or other screening.
"It's left to the consumer to argue with the insurance company for whatever services they say they performed," she said.
Slate says out-of-network charges are becoming more common as insurers set tougher limits on what they will cover. So it's likely that many more hospital patients, not just moms of newborns, will receive surprise bills in the mails, a few weeks after they go home.
As always, don't waste your money.
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FULL PEDIATRIX STATEMENT:
"Sarah Barwick's son did not receive newborn hearing screen services by the Pediatrix Newborn Hearing Screen Program. However, the unrelated charges have been resolved to her satisfaction.< We make it a priority to contract with all payors wherever we provide services, in order to avoid the confusion and financial challenges that an out-of-network provider may cause to patients. Today, virtually all of the services we provide in the state of Ohio are done so on an in-network basis. We also make every effort to communicate with families who may have some financial responsibility for our services, which is not uncommon in health care whether a provider is in-network or out-of-network, and encourage patients to contact us if they have any questions or financial hardship."
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