MECHANICSVILLE, Va. -- Paul Edwards’ teenage son began feeling sharp pain in his abdomen last fall. The family pediatrician advised Paul and his wife, Stacy, to take their son to the emergency room immediately.
That turned out to be a wise move, as doctors at Bon Secours Memorial Regional Medical Center quickly diagnosed the teen with appendicitis. Unfortunately for the Mechanicsville family, the emergency appendectomy required transport to another facility, Bon Secours St. Mary’s Hospital in Henrico.
“The whole time something could rupture and it be a serious issue,” Edwards told the CBS 6 Problem Solvers. “That’s why I didn’t think twice about it. I said ‘yeah, let’s do it.’”
Days after his son recovered, Edwards did a double take at the $2,742.31 bill he received from the ambulance company, American Medical Response (AMR).
“When I saw that ‘you may owe the ambulance company,’ I thought for real?” Edwards, describing the cost of his son’s 15-mile ride shocking, said.
The Edwards family received what’s called a balance bill. Patients get these bills when a provider feels an insurance company’s payment isn’t enough to cover the total cost of the services provided. In this case, Edwards’ insurance, Anthem Blue Cross Blue Shield, paid AMR $677.48 for the transport between hospitals.
Balance bills are often sent by out-of-network providers working at in-network facilities.
“You would think you pay your premiums monthly, that you could go and get things taken care of and not run across an issue like this,” Edwards, who decided to reach out to the Problem Solvers after feeling he’d exhausted every other option for addressing the bill, said.
We reached out to Anthem on Edwards behalf. A representative said they work constantly to ensure physicians and services at in-network hospitals are covered at pre-negotiated rates.
“However, there are some providers, including some ambulance services, that choose not to participate in our networks. Choosing not to be in our networks allows providers, including ambulance services, to charge consumers excessive amounts, well above Anthem’s allowances for out-of-network services,” Director of Corporate Communications Scott Golden wrote in a statement to CBS 6.
After our inquiries, a patient advocate for Bon Secours reached out to the Edwards family to notify them there is now a $0 balance on the AMR account. It is unclear if Anthem paid the bill or if AMR dismissed the charges.
Golden said Anthem feels consumers should be taken out of the middle and held harmless. While the Edwards' bill might be resolved, there does not seem to be a broader solution in the works. AMR told the Problem Solvers they actively negotiate agreements with insurance companies but it’s not always easy to reach a fair and reasonable rate.
“Unfortunately, in some markets, commercial insurance carriers have made it a point to narrow their networks. Some insurers are simply unwilling to pay or contract at rates that cover a provider’s operating costs. These two factors place more burden on those who are covered by commercial insurance,” a representative for AMR wrote in a statement to CBS 6.
For its part, Bon Secours stands by the decision to move Edwards’ son from Memorial Regional to St. Mary’s, saying doctors must do what is best for the patient regardless of cost concerns.
“While third-party bills do not originate from Bon Secours, we do provide financial assistance for both the insured and uninsured patient who receives emergency or other medically necessary care from any of our hospitals,” writes Jenna Green on behalf of the hospital system.
Edwards is happy to have his bill resolved but believes there needs to be some sort of regulation to keep more families from receiving surprise bills. There are no federal laws to stop the practice, though 28 states have enacted some form of legislation to prevent balance billing. Virginia is not among them. Currently, there are zero measures in place to protect healthcare consumers in the Commonwealth.
“I feel it needs to be addressed and more people need to fight for what they feel is right,” says Edwards. If you have received a surprise medical bill, send the Problem Solvers as many details as you can here.