Scott Kohan was taken by ambulance to an emergency room in Austin, Texas, in late January with his jaw broken in two places due to a violent attack. When he woke up the next morning, a nurse explained he needed jaw surgery that night. After confirming the hospital was in his insurance network, he decided to go through with the surgery. However, he still ended up with a $7,924.13 bill, according to Vox.
"A week later, I was obsessively checking the Humana website," Mr. Kohan told Vox. "I saw that everything came up in network except a bill for surgery that it says was rejected."
When Mr. Kohan contacted his insurance plan, he was told the physician likely coded the visit incorrectly and the claim would be resubmitted. When the physician resubmitted the claim, he increased the price of the surgery by more than $2,000. Mr. Kohan's health plan once again denied the claim, according to Vox.
Mr. Kohan was stuck with the bill because although the emergency room was in his insurance network, the oral surgeon who performed the procedure on his jaw was out of network.
In April, the physician's office began billing Mr. Kohan directly, requesting he pay the bill in full.
Vox contacted the physician and spoke to the office manager, who said the physician does not participate in any insurance networks. This isn't uncommon in Texas. According to data from the Center for Public Policy Priorities, an Austin-based think tank, a significant number of emergency rooms in Texas have zero in-network emergency physicians. Although the number varies among payers, CPPS estimates, for example, that 63 percent of Texas hospitals have zero in-network ER physicians for Humana patients, according to Vox.
The day after Vox spoke with the physician office manager, the office contacted Mr. Kohan to inform him the $7,924.13 charge was being dropped.
Mr. Kohan's bill is one of 1,300 submitted to Vox's ER database project.
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