ER doctors may not take insurance; even if hospital does - WFSB 3 Connecticut

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ER doctors may not take insurance; even if hospital does

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GOODYEAR, AZ (CBS5) -

A Goodyear man says he feels duped by an emergency room doctor. He had to pay thousands of dollars for services he expected to be mostly covered by his insurance plan. His experience is a common practice in hospital ERs, and there is little consumers can do about it.

The setup in most hospitals nationwide is perfectly legal. Emergency room doctors are not generally employees of the hospitals they work in. Just because a hospital in "in-network" with your insurance, that doesn't mean the emergency room doctor is. In fact, there's a good chance that an emergency room doctor doesn't take any insurance at all, and that could lead to big out-of-pocket expenses for you.

Richard Davis badly dislocated two fingers last year, when he tripped and fell outside his house. With his Blue Cross, Blue Shield insurance, he went to Banner Good Samaritan Medical Center for treatment.

"It was a Banner hospital and we knew that they were in-network so we had no reason to believe this doctor wouldn't have been in-network also," Davis said.

Davis says insurance wasn't discussed at the hospital. He says the doctor, Lloyd Champagne, spent less than thirty minutes resetting his fingers. Insurance covered the hospital charges, but Davis got a massive bill from Champagne's practice, the Arizona Center for Hand Surgery.

"Almost $11,500 for 20 minutes of service in the ER by this doctor," Davis said.

Turns out Champagne doesn't take any insurance, hospitals don't require emergency room doctors to accept it and many don't. Most emergency room doctors are independent hospital contractors who can bill as they please. The Center for Hand Surgery reduced their bill to $9,600, but Davis says his insurer thought about $2,000 was customary and reasonable. He asked The Center for Hand Surgery to accept the lower amount as full payment.

"They refused. That was it. That was all they were going to do, and if we didn't pay it, they'd send us to collections," Davis said.

Davis paid almost $8,000 out of pocket for something that would have cost very little had the emergency room doctor taken his insurance.

"There are patients out there that are being bilked out of huge amounts of money for procedures that shouldn't cost that much," Davis said.

Hospitals have been hiring independent contractors to run their emergency rooms for years, but many consumers are still shocked when they find out. Most insurance will only pay the out-of-network rate to that doctor, and they'll only pay what is customary and reasonable.  So patients like Davis, who get an extremely large bill, are stuck with a huge balance.

CBS 5 News contacted the Arizona Center for Hand Surgery and Dr. Champagne several times wanting to discuss why this bill was so high, but no one from the practice returned our calls.

There isn't much you can do, if you are in a life/death emergency, you should go to the closest emergency room.  But if it is not life/death, ask the emergency room staff if the physician on duty takes your insurance, if not, assess if you can go elsewhere.

Copyright 2013 CBS 5 (KPHO Broadcasting Corporation). All rights reserved.

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