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What Hoosiers need to know about surprise medical bills — and how to prevent them

In 2017, one patient out of every six visiting the emergency room or staying inpatient at a hospital came home with at least one out-of-network medical bill.

Bob Segall, Allison Gormly

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Published: 5:00 AM EDT October 28, 2021
Updated: 11:37 PM EDT October 28, 2021

Aleece Raw remembers the moment she opened the bill. Her heart sank.

“I kept staring at it, and I just couldn’t believe it because it didn’t make sense,” she recalls. “I almost had a heart attack.”

The $5,294.92 invoice arrived about a month after Raw had a routine colonoscopy at a hospital in Carmel. She had good reason to believe the procedure would be fully covered by her insurance.

“I contacted my insurance company before the procedure specifically to make sure that colonoscopies were covered, and they said they were,” Raw told 13News. “In-network screenings are covered at 100%, and so that’s when I looked up the doctor, saw the doctor on their website and said, ‘Yeah, I’m good.’”

Raw also asked the hospital if its facility was considered in-network by her insurance plan. An e-mail confirmed it was.

In-network hospital. In-network doctor. Routine procedure. It all seemed simple — until the bill arrived.

Months later, Raw says neither the hospital nor her insurance carrier have been able to explain why she got a medical bill for more than $5,000. An explanation of benefits from the insurer suggests some of the services rendered during her colonoscopy at the in-network hospital were billed at out-of-network rates – a widespread practice known as “balance billing” that results in patients bearing responsibility for unexpectedly large medical bills.

That type of surprise billing impacts millions of Americans and costs billions of dollars annually, but it isn’t supposed to be happening.

Nearly two years after state lawmakers passed legislation to curb surprise medical bills in Indiana, 13 Investigates has found the problem continues — much to the dismay of patients, state leaders and hospitals.

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