Harold Cox received a $2,077 charge during Blount Memorial Hospital’s emergency department visit. Cox stated that he visited the emergency department three times in 2021 and was not charged for the other two visits.
APP of Tennessee ED PLLC introduced the bill. Blount Memorial said they had an agreement with APP of Tennessee to supply “emergency department providers.”
Cox offers a supplement to Medicare through United Healthcare. Blount Memorial Hospital accepts his insurance, but not the APP of the Tennessee ED PLLC firm.
Cox believes he received a ‘balance bill.’ Balance billing is a term that refers to the difference between what patients owe and what they owe when they receive care from an out-of-network provider. The patient gets billed for the portion of the cost that is not covered by insurance.
According to the Department of Health and Human Services, hospitals are “prohibited” from paying Medicare and Medicaid patients on a balance billing basis.
10News inquired with United Healthcare why Cox was billed for emergency department treatment. United Healthcare said that the bill originated with APP of Tennessee and that the insurance company was ignorant of it.
Following our phone conversation, United Healthcare’s patient advocate and Cox contacted APP of Tennessee, informed that the charge was incorrect. APP informed Cox of Tennessee that they would dismiss the charges and send him a confirmation letter.
The No Surprises Act was enacted by federal lawmakers and took effect on January 1, 2022. The new rule prohibits private insurance holders from “getting unexpected medical expenses when they obtain most emergency care.”
WBIR is doing an investigation into how hospitals bill their patients. In Tennessee, hospitals must publish a list of their regular costs for commodities and services.
Patients frequently report being surprised by their medical bills; these shocks are frequently the result of hospital errors: a service that should have been preauthorized but weren’t, the hospital billing the incorrect code, or the hospital erroneously classifying a procedure.