Surprise Medical Bills Said to be a Leading Cause of Bankruptcy in Wisconsin

Imagine this, you schedule an in-network medical procedure and are assured your insurance will cover the cost. A few weeks down the road you receive an out of network bill.

It’s a scenario a study found is seen far too often in Wisconsin and is even beating out bigger urban cities like L.A. and New York.

The study, published in the Journal of American Medicine Association, found that certain doctors are most likely to send you that surprise medical bill, and in the state of Wisconsin you’ll likely face a charge that is three times more what big cities likely charge.

Just over a year ago, Anne Rogalski went to her doctor for a routine check-up.

“They thought they felt something in my gut area,” say Rogalski. “So he (her doctor) suggested we do a colonoscopy and make sure it’s nothing.”

A simple enough procedure Rogalski was confident would be covered by her insurance. Leaning on the side of caution however, she made a couple calls into the surgery center week prior to the procedure.

“I talked to the girl who handles the insurance and asked if she would make sure everything is covered,” explains Rogalski. “She said no problem.”

The procedure took place on March 3, 2016. A few weeks later a bill arrives in the mail seeking more than $1,400 in payment.

“They (her insurance) paid for doctors time, they paid for facility charge, but they didn’t pay of the anesthesiology,” says Rogalski.

That’s no surprise to researcher Ge Bai who says the average anesthesiologist charges more than 4 times what the government recommends, often leaving privetly insured consumers, like Rogalski, with an outstanding debt with the hospital.

Reserchers found the average anesthesiologist, emergency physician, pathologist, and radiologist are most likely to send those surprise medical bills for a main reason.

“They do not have a predetermined rate with a provider,” says Bai.

Bai believes the problem is that people can’t choose the doctors with the highest markups like anesthesiologists.

Among all states, Bai says Wisconsin sits at the top of the list for highest markups including the Milwaukee area.

“Big metropolitan areas have an incentive to charge a higher rate but then you have Wisconsin at the top of the list, and then we have Milwaukee out of nowhere among all these metropolitan areas,” says Bai. “So, that is something quite interesting and needs further investigation.”

As of now, there is no state law that protects people from these situations or that places a cap on how much doctors can charge.

According to Healthcare Blue Book, the total cost of Anne’s procedure should have cost just over $1,500 with an anesthesia fee of $491, a far cry from the $1,400 bill she was sent.

“I wish I could say that Anne’s story is unique, but in fact I have folks who call my office with the same problem,” says Mellissa Sargent (D) Madison.

Representative Sargent has a bill in the early stages that would require full transparency between a medical provider and a patient before a scheduled procedure.

“What the legislature needs to do is step in and say to providers, all across the state, when you are providing care for someone you  need to let them know when the care that they are receiving is not going to be covered by their insurance,” says Sargent.

Anne took her situation a step further by reporting the discrepancy to the Better Business Bureau and even writing a letter to the billing company. But the reports made no difference. Facing a collections notice Anne knew she had no other choice.

“In about 5-7 years I’m going to retire and I have but perfect credit now,” says Anne. “I talked to my husband and we decided that it would be best if we paid,”

“That’s why I feel so passionate about this piece of legislation because nobody should be faced with the decision that feels unpalatable,” Says Sargent.

“I don’t think it’s ethical. It really isn’t,” says Anne.

Sargent plans on introducing the bill within the next year after receiving feedback from consumers, providers, and other legislators.

For now, billing experts suggest talking with your insurance company and the provider about the surprise bill.