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  • Gary Mauney

ARE YOU A VICTIM OF HOSPITAL “BALANCE BILLING”?

Mauney PLLC is investigating unfair and deceptive hospital “surprise” billing.

Charlotte attorney Gary Mauney and Mauney PLLC stand ready to challenge unexpected hospital bills, also known as “balance billing.” If you were hit with a surprise medical bill from an out-of-network provider after being treated you may have a legal claim. Contacting an experienced medical bill lawyer could help you determine if you are entitled to compensation for surprise medical expenses or unexpected out-of-network charges, at no cost to you.


National Public Radio (NPR) recently reported the story of Carolinas Medical Center patient Joshua Bates. Last year, Bates developed a high fever and discovered he could barely move without experiencing a sharp pain in his stomach. Bates knew that something was seriously wrong. Bates called his roommate, and the two of them drove to the emergency room at Carolinas Medical Center (owned by Atrium Health) in Charlotte. The emergency doctors at Carolinas Medical Center (CMC) immediately administered several tests, including a CT scan of Bates abdomen. The scan revealed an acute appendicitis, minutes from the point of rupture.


The emergency doctors at CMC immediately performed surgery to remove Bates' appendix. The surgery went smoothly, and Bates was discharged from the hospital the next day. Bates was relieved that his medical ordeal was over. But he soon found out it was not.


Bates is a technical recruiter for a staffing firm in Charlotte - a job that provides health insurance as a benefit. His health insurance, “The Continental Benefits” insurance plan, had a deductible of $2,000 and his annual out-of-pocket maximum was supposed to be $6,350. His total bill was $41,212, which covered the surgery, one night at the hospital, and emergency room charges. After payments by both Bates and his insurer, the hospital sent Bates a bill for the balance, just over $28,000. Needless to say, Bates, who “had insurance,” was not expecting a bill for $28,000. A surprise, and not a good one.


Bates soon found out that he’d been “balance billed” because he had gone to an out-of-network hospital. Since it had been an emergency, Bates had, of course, gone to the nearest hospital. A “balance bill” is the difference between what insurers pay toward a bill and a provider’s “list charges,” which hospitals and laboratories set themselves and which often bear little or no relationship to actual costs. In Bates’ case, the insurer paid $8,944 toward the $41,212 in charges, according to the explanation of benefits (EOB) he received from his insurer. On top of that, Bates paid the hospital about $4,000, a combination of his annual deductible and his coinsurance for emergency care. That left $28,295 of the hospital’s charges unpaid.

Pretty soon thereafter, CMC sent Bates’ $28,000 unpaid balance to collections. Bates' personal insurance refused to cover this portion of his bill. Predictably, this unpaid bill harmed Bates’ credit score. The charges remain unpaid.


Unfortunately, Bates situation is not unusual. A recent study reveals that about 18% of all emergency room visits result in at least one charge for out-of-network care. Patients are fighting back against these practices by bringing class action lawsuits in appropriate situations, such as when there is no warning that physicians in the emergency departments are not in-network and send them a bill, often an enormous one, after their visit.


If you were hit with a surprise medical bill from an out-of-network doctor or at in-network hospital, you may be entitled to compensation. Contact Mauney PLLC for a free and confidential case evaluation at info@mauneypllc.com or call us at 704/945-7185.