MARYVILLE, Tenn. — Harold Cox got a bill for $2,077 after a visit to the emergency room at Blount Memorial Hospital. Cox said he went to the emergency room three times in 2021 but didn't have to pay the other two times.
The bill came from APP of Tennessee ED PLLC. Blount Memorial said they contract with APP of Tennessee for "emergency department providers."
Cox has a United Healthcare supplement to Medicare. His insurance is in-network with Blount Memorial Hospital, but not with the APP of Tennessee ED PLLC company.
Cox said he thinks he got a 'balance bill.' Balance billing is used to describe the difference patients owe when they're treated by an out-of-network provider. The patient is billed for the balance of what insurance doesn't cover.
The Department of Health and Human Services said hospitals are "prohibited" from balance billing Medicare and Medicaid patients.
10News asked United Healthcare why Cox was billed for his services at the emergency room. United Healthcare said the bill came directly from APP of Tennessee and the insurance company was unaware of the bill.
After our phone call, United Healthcare's patient advocate and Cox called APP of Tennessee, and they said the bill was a mistake. APP of Tennessee told Cox they would remove the charges and send him a confirmation letter.
Federal lawmakers passed the No Surprises Act, which went into effect on January 1, 2022. The new law prevents people with private insurance from "receiving surprise medical bills when they receive most emergency services."
WBIR is looking into how hospitals bill their patients. Hospitals in Tennessee are required to publish a list of standard charges for items and services they provide.
Patients report surprises in their medical bills, sometimes they’re from errors the hospitals make: a procedure that should’ve been preauthorized but isn’t, the hospital billed the wrong code, or they incorrectly classified a procedure.
If you get a bill and see something wrong, contact the hospitals and the insurance company. If they don’t help solve your problem—contact us at: iteam@wbir.com, to see if we can help.