ER Care: Does a Hospital Have to Accept Your Insurance?

[SPL Tech]

Say one day you get hit by a car and have to go to the ER. You finish up with all the stuff the doctor had to do to fix you, and you get to the payment part. You hand the hospital your insurance card, say Blue Cross Blue Shield. Then they say, "Sorry, we dont accept BCBS" and they hand you a bill for $100k. Is this a realistic scenario?

I know under the ACA, insurance companies must treat all ER care as "in network" and therefore pay for it. However, do all hospitals have to accept your insurance company's payment as payment in full, or can they refuse to accept your insurance all together (or charge you more in addition to what the insurance-negotiated rate covers)?

I would envision if the ACA did not require all ERs to accept insurance as payment in full from any ACA-complient insurer, then going to the ER is a total gamble as you have no idea if they accept your insurance or not (and you cant exactly ask in a legit emergency).

 

[Tkruger]

In the instance of a TRUE Life or Death Emergency only....They will stabilize you then transfer you to an in network facility.

 

[bluediamond]

Ok, let's bring ambulance service into this scenario. True life and death emergency, ambulance out of network, can ambulance service balance bill as out of network?

 

[MBSC]

It depends on the state regulations. In the attached link, see column 5 (HMO) and column 8 (PPO) restrictions on balance billing by OON providers.

State Restriction Against Providers Balance Billing Managed Care Enrollees | The Henry J. Kaiser Family Foundation

 

[yorkriver1]

In the instance of a TRUE Life or Death Emergency only....They will stabilize you then transfer you to an in network facility.

Just had client hit head on by a drunk driver. Closest hospital did just that. Stabilized, then sent to the in network hospital.

Now, it will be interesting how the health plan handles collecting from the auto insurance/legal settlement involved. For now, they have some big expenses.