SURPRISE…I Owe What?

On April 14, 2016, our state passed the Surprise Medical Billing Law to protect Floridians from unfair medical bills. However, many still receive ‘surprise’ medical bills from inadvertent out-of-network health providers or facilities. Such was the case with our client Chantelle who received a ‘surprise bill’ for $10,000.

Chantelle – a fictitious name but a real person – called our firm to take on the fight. Her story is one to remember if you or anyone you know gets stuck with an inadvertent or surprise out-of-network medical bill.

Chantelle is a registered nurse and the mother of Lacresha, a 5-year-old Kindergartner who broke her arm and needed a pediatric orthopedic surgeon. To avoid a surprise medical bill, Chantelle contacted her insurance administrator to locate an in-network pediatric orthopedist and received permission to use a provider that was closer to her home practicing at a nearby surgical center.

Bummer Alert

A few weeks later, Lacresha’s arm was healing, and Chantelle was about ready to make a phone call to me. Why? Because when she opened up the mailbox, she discovered a ‘surprise’ bill for $10,000!

Even though Chantelle had contacted her insurance administrator to get pre-approval to use a specialist physician that was in-network, the facility where he practiced was not in-network. Chantelle had no way of knowing this before her daughter underwent treatment at the medical facility because her insurance administrator’s customer service person did not alert Chantelle that the facility was not in-network. Consequently, Chantelle received a ‘surprise’ medical bill for thousands of dollars.

When Chantelle came to our law firm, we appealed the decision that allowed the out-of-network medical facility to charge Chantelle $10,000. We argued that Florida’s Surprise Medical Billing Law prohibits an insurance carrier from disclaiming responsibility from coverage under Chantelle’s circumstances because she is not able to choose the facility where her provider practiced.

It was a welcome surprise when we received a call from the appeals committee informing us that Chantelle and her daughter won their case. CASE CLOSED.