Frustrated over unexpected medical bills?

Iwish to commend The New Mexican and journalist Bruce Krasnow for the informative article about “surprise” medical billing (“State official takes aim at surprise health care billing,” Dec. 22).

As a practicing physician in Santa Fe for 17 years, I have witnessed firsthand the financial hardship imposed on our citizens by surprise medical and hospital bills. I would like to suggest some additional solutions to this horrific problem.

Because of a shortage of physician specialists in Santa Fe, medical centers such as Christus St. Vincent Regional Medical Center are periodically under pressure to quickly hire locum tenens (temporary) emergency room and other specialist doctors from other parts of the country before there is sufficient time to get them contracted with all commercial and federal insurance companies so they are in-network with all insurers.

As noted by Krasnow, a recent survey found that 55 percent of New Mexicans who visited an emergency room received surprise, very expensive bills. What can citizens do to protect themselves from “surprise” bills not covered by their insurer?

Before you have any medical procedure, find out in advance what medical services will be carried out by out-of-network providers, including if unpredictable complications arise. If you may require post-operative physical rehabilitation, for example, carried out by out-of-network providers, find out if rehab can be done at a facility with doctors who are in-network. Don’t be shy about finding out the approximate cost of all services you will receive, because you don’t like financial “surprises,” especially around holiday time.

Should you need and decide to have medical procedure by an out-of network specialist, consider negotiating the cost closer to what an approved amount would be if you were in-network. If you receive an unfair surprise bill, give your doctor and hospital the benefit of the doubt and try to resolve your concern with the billing manager. It may be a simple coding error when the bill was submitted. If not satisfied, and it involves a New Mexico commercial insurer, you can file a complaint with the Office of Superintendent of Insurance John G. Franchini’s office, at www.osi.state.nm.us or call 855-427-5674. What can hospitals and doctors do? If locum tenens doctors are needed, hospitals should strengthen their efforts to get doctors contracted with New Mexico commercial and federal insurers before starting work. Insurers save money if those they insure use out-of-network doctors. Hospitals, clinics and other facilities should post signs in the admitting office and other visible areas recommending patients and staff to thoroughly discuss with potential patients the possible need for services that may be out-of-network so patients can make more informed decisions and plan accordingly for their financial responsibility.

Lawrence Lazarus, M.D., is in part-time private practice in Santa Fe and co-author, with Dr. Jeff Foster, of the forthcoming book, Our Fast Changing Health Care System — What Every American Needs to Know.

Before you have any medical procedure, find out in advance what medical services will be carried out by out-of-network providers, including if unpredictable complications arise.