Phil Heidelberger did what savvy patients are supposed to do.
When he needed a cardiac procedure in 2007, the semi-retired Fort Worth salesman confirmed ahead of time that his doctor and the hospital belonged to his health insurer’s network.
That way, he'd be sure to avoid the extra expense that comes with treatment at outside facilities.
Here's what Heidelberger didn't know until it was too late: The anesthesiologist who assisted on his case didn't have a contract with the health plan.
It's a distinction that could cost him a whopping $1,005.
What Heidelberger encountered was an all-too-common practice known as "balance billing," which has drawn complaints for years from hospital patients, lawmakers, and regulators nationwide.
It happens when anesthesiologists, pathologists, radiologists and emergency-room physicians at a hospital on a health plan’s network aren’t on the network.
Those out-of-network doctors, who don’t have an agreement with the insurer for discounted fees, can demand full price.
Then, insurers can determine what portion of the bill they're willing to pay. And the physicians can collect the remainder of the tab from patients.
Read the complete story at star-telegram.com