Seattle Man Gets Unpleasant Health Insurance Surprise
On a recent ER visit, Greg Bulmash learned the expensive way that even though the hospital took his health insurance, the Emergency Room doctors didn't.
Seattle, WA (PRWEB) March 27, 2006 -- When Greg Bulmash woke up in the middle of the night with fever chills from an out-of-control infection, he went to a hospital that was listed as a preferred provider by his insurance and thought he was covered for everything that would happen there. He was wrong.
It turned out that while the hospital accepted his insurance, the Emergency Room there was staffed entirely with doctors who didn't. The hospital didn't have to tell him this, the doctors didn't have to tell him this, and this little lack of information cost him an extra $153.50.
"It came as a real shock," said Bulmash, who has documented his experience at his new web site, http://www.DoctorTricks.com. "Because of a mail mix-up, I first thought I was going to have to pay the whole bill. Then I found out my insurance was going to pay about 75% of it and was relieved. But then I said 'hey, wait a minute,' because my insurance was supposed to cover 90% of it."
Sadly, the 90% was for doctors who charged the insurance's approved rates. Because the ER doctors didn't accept his insurance, they could charge more than the approved rates and he was responsible for paying the difference.
But when Bulmash tried to determine where he could go if he needed to go to an Emergency Room again, he found another boondoggle. "To find this in my insurance company's online provider directory, you don't search under 'Hospital' facilities. You have to search under 'Emergency Medicine' facilities. Then the search results list the name of the doctors' group that bills for the Emergency Room services, and in 3 out of 7 Emergency Rooms within 40 miles, that name was not the same as the hospital. I had to use Google to cross reference the address of the nearest Emergency Medicine facility to determine that it was in a hospital and wasn't some strip-mall urgent care center."
To tell the story of what happened to him and what he learned as he tried to navigate this confusing maze of directories, rules, and policies, Bulmash has started a web site at http://www.DoctorTricks.com. "I wanted to share my experience," he says. "Consumers need to know what their options are, but there's this maze they have to navigate. Getting the knowledge you need to make an informed decision is really tough."
"I'm not trying to say 'poor me' to the world and seek sympathy. At http://www.DoctorTricks.com, I want to start a dialogue. I want consumers like me to share their stories of how they ran into unexpected charges, and more importantly what they learned about working the system to avoid them the next time."
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