KREM 2 gets answers on large, unexpected E.R. bills

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by Katie Utehs & KREM.com

KREM.com

Posted on April 27, 2012 at 2:25 PM

SPOKANE – Patients of Providence Holy Family Hospital are caught in the middle of a battle between doctors and a major insurance company. 

The Emergency Room doctors, who are independent of the hospital, are no longer contracted with Premera Blue Cross.  Customers are now opening large, unexpected bills after treatment at the Emergency Room.  After KREM 2 introduced this story Thursday, people began contacting us with the same problem.

Many people are looking at medical bills they can’t afford to pay.  KREM 2’s Katie Utehs spent Friday talking with the Insurance Commissioner’s Office, Holy Family and the Emergency Room Physician’s Group.

Premera says they notified customers that the Emergency Room doctors’ contract with the insurance company dissolved on October 1st.  Officials say they sent letters to their members with a North Spokane zip code and who live within a five mile radius of Holy Family Hospital back in September of last year.  They say they also contacted members who live outside of that radius who visited the hospital Emergency Room at Holy Family Hospital within the last 12 months.

Some customers say they never received anything in the mail.  KREM 2 contacted the state’s Insurance Commissioner’s Office, and they say Premera notified them of the change and told them customers would be receiving a letter.

Officials say the insurance company has to tell you 15 days before they are going to cancel a contract, and they must do it in writing. 

If customers didn’t receive the letter of notification from Premera, they won’t receive hear anything about it at the hospital.  The hospital spokesman says it “could be construed as financial coercion” if they were to inform patients with Premera insurance coverage, and they must treat everyone who comes in.

The hospital and Emergency Room Physician’s Group say they are required to do a medical screening in the Emergency Room before payment is discussed.  They say it is a federal law known as the Emergency Medical Treatment and Active Labor Act.

If you are in the same situation, you can call the Insurance Commissioner at 1-800-562-6911.
They can discuss you rights and will investigate cases if necessary.

Officials say Premera and the Emergency Room Physician’s Group have reached a tentative agreement.  They hope to have a formal agreement and announcement soon.

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