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Out Here: Health care and unexpected bills

Published: Thursday, Dec. 19, 2013 11:18 a.m. CDT

I used to pay little attention to what my insurance policy covered. I became more acquainted after I had emergency surgery to my intestines in July.

Over the past few weeks, I've written stories on the Affordable Care Act, commonly known as Obamacare.

One thing for sure: Insurance is expensive for most people. Sure, you can get a relatively low premium, but that means you probably have a deductible of $6,000. Ouch! Not many people have that kind of money sitting around.

I have talked with a number of residents who are contemplating what they'll do if they lose their policies. Those who are older and self-employed have options – all expensive.

Those who get insurance through their employers, as I do, are more fortunate. But we find ourselves with unexpected bills, too.

In November, I detailed my first dispute with my insurance company. It informed me it would pay for my surgery, but not the $2,700 for anesthetics.

I told the company that my policy covered anesthetics, but my insurer responded that the person who administered them wasn't in-network. At one point, a company representative told me I should have asked the person whether she was in-network.

The company backed down, thankfully, realizing that no one could be expected to do that in an emergency, especially at an in-network hospital.

On Dec. 3, I received another notice from my insurance company that I had to pay $671 for blood work in August, which was called a "molecular pathology procedure Level 2."

This helped the doctor to determine the situation with my digestive system and what I should do about it. In my mind, it was worth it.

But I'm no expert. My insurer said it consulted its medical director, who "carefully reviewed all available pertinent clinical documentation."

The "clinical rationale" for not approving the expense: "There is insufficient evidence in the peer-reviewed medical literature to support the effectiveness of this intervention, especially with respect to long-term health outcomes."

The insurer must have already let the hospital know, because 6 days later, the hospital sent me a letter asking for the money. 

"If you have an unusual financial problem, please contact [us] immediately," it said in a letter.

My problem was that I didn't see this charge coming. In America, that's not so unusual.

Our health care system spends billions and billions of dollars on figuring out who owes what. That process involves much uncertainty, at least for patients.

David Giuliani is a news editor for Sauk Valley Media. You can reach him at dgiuliani@saukvalley.com or 800-798-4085, ext. 525. Follow him on twitter: @DGiuliani_SVM.

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