Medical bills exceed amount quoted

December 22, 2016

Dear Consumer Ed:

I recently underwent outpatient surgery.  The doctor’s office told me that my out-of-pocket costs would be $525.  I paid the money and had the procedure.  A month later I received two bills: one for $150 for the anesthesiologist and one for $110 for the surgeon.  I don’t think I should have to pay these bills because I was told ahead of time that I only owed $525.  However, I am concerned that if I don’t pay these bills, it will hurt my credit rating.  What should I do?

Consumer Ed says: 

One medical procedure can often result in multiple bills.  In the health care field, the entities charging for services are known as “providers.”  These providers often work for different companies that bill for their services separately.  For example, a surgical biopsy could result in as many as four separate invoices:  1) from the surgeon who performs the biopsy, 2) the anesthesiologist who provides local or general anesthesia for the procedure, 3) from the laboratory pathologist who examines the tissue sample, and 4) from the hospital or other facility where the procedure is performed.

More and more frequently, facility providers are requiring patients to pay out-of-pocket costs prior to scheduling nonemergency surgical procedures.  While some outpatient surgical centers are all-inclusive and some surgeons do agree to limit patients’ total out-of-pocket costs, often these prepayments cover only the services provided by the facility itself, such as staff and use of equipment, and not the services of other providers. 

First you should carefully review all of your paperwork from the surgical procedure.  The paperwork that you received may clarify whether your payment was for the surgical facility’s (or another provider’s) services only.  You should also speak to your health insurance company.  Ask for copies of every EOB related to this procedure.  An “EOB” is an Explanation of Benefits, which is a statement that shows the service provided, how much the medical provider billed for this service, a lower amount that your insurance company has negotiated to pay for that service, how much your insurance company paid, and how much you owe the provider.  Make sure that the EOBs and the bills you received show you owing the same amounts.  These documents can be quite confusing.  If you do not understand the EOBs, do not hesitate to ask your insurance company to explain them.

If the surgeon and anesthesiologist invoices came from the same entity that you initially paid, then you should speak to that office and ask them to write off the additional charges. However, if those bills are from separate providers, then you might owe those amounts separately from what you paid to another provider already.  If you do not resolve the disputed bills with the providers, refusal to pay them may indeed hurt your credit rating.