KUSA — Patients left unprotected by current Colorado law and a nonexistent federal law must find ways to protect themselves from surprise medical bills.
As part of an ongoing 9Wants to Know investigation “Lien on Me,” it’s important for patients to know what they can do to lessen the chances of receiving a surprise medical bill that can stretch well into the thousands of dollars.
Knowing what to do before and potentially after a surprise bill arrives in your mailbox can make the difference -- not just to your bank account -- but to your sanity.
9Wants to Know has talked with advocates and attorneys to come up with some tips for patients to be prepared before an emergency and after a surprise bill comes.
Check your insurance card ... NOW!
Only about a third of people with employer-sponsored healthcare plans will have it, but you should take out your insurance card right now and check it for “CO-DOI."
That stands for Colorado Division of Insurance. If you see it on your card, you are in luck. Should you ever receive an out-of-network balance bill from a provider while seeking emergency care at hospital that is in-network with your insurance, you can file a complaint with the Colorado Division of Insurance.
Here is that link: https://bit.ly/2oSutmP
Under a 2006 Colorado law, patients with Colorado regulated insurance plans must be “held harmless” from out-of-network bills that stem from emergency, unplanned visits to area hospitals.
Here’s the bad news for the rest of us: If you don’t have CO-DOI on your card, your insurance plan is regulated on a federal level. As of now, Congress has passed zero balance billing legislation, but you’re not necessarily out of luck. Keep reading!
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Print this out
9Wants to Know has provided you with this note that you can either keep in your wallet, save to your phone or otherwise keep close in the event you have to go to an emergency room in Colorado.
It is NOT a legal contract and does not guarantee you won’t be balance billed, but it does serve as a reminder to hospital staff that you are an informed patient.
Feel free to print one out for friends and family. The more people who ask to put it in their medical files, the more hospitals will realize that patients are paying close attention to this problem.
Know the basics of your insurance plan
Don’t know what a deductible is? What about a co-pay or coinsurance? How big is your deductible? What is your out-of-pocket maximum? What is the most you would have to pay if you are seen by a provider not in-network with your insurance (that’s sometimes called an out-of-network out-of-pocket max)?
If you don’t know the answers to these questions, make some time to study your health insurance policy.
The less you know about your own plan, the more you will likely be surprised when getting bills from medical providers.
You've just gotten a balance bill from a medical provider you never chose
In most cases, the bill will also tell you to file an appeal with your insurance company. Many providers will tell you exactly how to do it.
Always appeal with your insurance company first. The company might have misprocessed the claim. The coding could have been wrong. Mistakes happen, and insurance companies often reconsider early denials.
Keep fighting too. Whenever you talk to an insurance company representative, ask for the case number. Write it down. Use it the next time you talk to someone with the company. Remind them of the work that has already been done on your case.
Stay in contact with the physician billing you. It can take a lot of time to call the provider and insurance companies, but it could save you money, and possibly help prevent a lawsuit.
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But if you have been sued for medical debt, here's what to expect
9Wants to Know made this video to help people try to maneuver what can be a complex system. The most important lesson here is also the most simple: Do not ignore a summons.
A judge will always issue a default judgment (that’s bad) if you decided not to show up to court.
A default judgment could mean that your wages will be garnished and could result in a lien on your property.
Once you’re in court – remember that you still have rights. You don’t have to talk to the attorney who is suing you, unless you want to. If that attorney starts asking you questions you’re not comfortable answering, you don’t have to continue the conversation.
You can also file an answer – which costs a little over $90 in Colorado. If you cannot afford the fee to file the Answer to the Summons, you may ask the Court to allow you to file without paying the fee.
Here’s a link to some important forms on the Colorado courts website: https://bit.ly/2Qv5pyf
Colorado Legal Services also has helpful tips on consumer protection posted to its website: https://bit.ly/2PIAvVZ
You can call Colorado Legal Services directly for additional guidance if you’re currently being sued.