Wauxha County – After an emergency treatment, the word “out of network” is the last word you want to hear. A surprise bill has asked a Wauxha County family to write to Contact 6.
Chuck and Kirsten Nelson played the hand that dealt with Chuck when he was paralyzed in a motorcycle accident.
“It’s more of a spinal cord injury,” said Chuck Nelson.
Then, 18 months later came to an emergency hospital.
“I believe my blood pressure was severely low,” Nelson said.
The Nelsons were 180 miles from home, so Kirsten says Human Insurance.
“They said just go to the nearest place and get you treated,” Kirsten said. “Our bill was 8 850. It’s a lot of money that I didn’t really feel we should be responsible for. “
Contact 6 wrote to Humana and said it was an example of “out of network balance billing”. This can happen when a patient unknowingly receives services from a provider outside of a network.
“You don’t have the power to say, ‘I’m sorry. I want to make sure everyone is treating me like an in-network provider,'” Chuck said.
Chuck has been treated at Black River Memorial Hospital for contacting it. It has “tried more than once in the last few years to become a network provider without any response from Huma over the years.”
“The hospital eventually sent us for collection,” Kirsten said.
But both Humna and the hospital seem to agree on one thing – Nelson shouldn’t be in this position first. They say the communications are about 6 in almost the same word that they are in favor of federal and state policies to unite “members of our commercial insurers and patients from this right thing to do”.
“We need to find a way to keep the patient from getting caught up in this kind of thing,” said Mark Grapantine of the Wisconsin Hospitals Association.
But the Wisconsin Hospitals Association says hospitals and insurance companies have different ideas about how to close it.
“The hospitals that support it create an independent dispute resolution process,” Grapantine said.
This means that hospitals and insurance providers sit down with a mediator to discuss network bills outside of a network before they hear about the patient.
Another option, however, is that insurance companies often support it – setting standard rates for care, which makes billing unnecessary.
“I feel like people are taking a real chance,” Kirsten said.
After arriving at Contact 6, Nelson Humaner received a call.
“They found a way to pay at least a few hundred dollars more for the bill,” Kirsten said.
If you have a problem with a medical bill, you can ask the Wisconsin Office of the Insurance Commissioner to review it.
The Nelsons did but were told Humna did not violate any insurance laws or regulations.
Last year, some Wisconsin lawmakers proposed a bill to prevent billing outside the network. Dozens of states have passed similar laws. But many believe the issue should be handled at the federal level.