Insurance Emergencies - Newschannel 6 Now | Wichita Falls, TX

Insurance Emergencies

Many of us have health insurance and we pay a lot for it, but more people are discovering, when they face a medical emergency, they are faced with a huge bill.

It's not just an issue in Texoma.  It happens all over the state with hospital systems.

“People think, well my hospital is in the network, so we're good,” Kelly Fristoe with Financial Partners said, “They don't know to look to see if the doctors the contracting entities, they don't know to look at those things.”

The E.R. is the most expensive place you can go to get treatment, so it's very important to research which physicians are in your network.  However, even if you do the research, you don't really have control over who will treat you.  Especially, if it's an emergency.

Fristoe said, “When your unconscious and they're trying to put you back together, whether it's a heart attack, or a stroke, or a car wreck, where someone's trying to save your life, a bonafied emergency, that doesn't matter.”

Regardless, you're covered because of the federal law.  Physicians have to treat you if you go to the hospital.  The only difference is the bill at the end.  However, this is a law Congressman Mac Thornberry wants to change.

“We ought to look at changing that law, so that if you show up at an emergency room, you don't really have an emergency, they'll send you off to the local clinic, or something like that,” Congressman Thornberry said.

It might seem like your insurance company isn't paying a penny, but they are.  You're just paying the remaining balance.

“It's not like your insurance company isn't paying,” he said, “They're paying, just not what the retail cost is that they're charging.”

Fristoe said some people will go to the emergency room when it's not really an emergency.  For some, they don't know any other place to go, or when they have time to go see a doctor, their primary physician's office is closed.

“There are people that just get desperate like that, cause they don't know,” he said.

Another issue, people don't educate themselves enough with their options.

“The education is what you get when you read the fine print and experience is what you get when you don't, but nobody reads the fine print anymore,” he said.

He added that insurance wasn't as complicated in the past, but with the Affordable Care Act he said it's gotten worse.

“It is complicated and the average person isn't going to take the time to learn how it works,” he said.

Congressman Thornberry said the ACA is a problem and he will continue pressing the issue.  He believes they need to get rid of it and start over.

If you do get a massive bill, you can always try to lower it under the House Bill 2256. 

“House Bill 2256 allows for us to mediate that and if we felt like that we were not informed properly the consumer has some protection mechanisms built in that is state law,” Fristoe said.

There are a lot of requirements to be able to challenge the cost.  Click here to see those requirements.

Alexandra McClung, Newschannel 6
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