When the Hospital Is Covered but the Health Care Isn’t

It's getting harder and harder to keep medical costs within your insurance network—even during a single hospital stay.

Surprise medical bills from out-of-network providers are an all-too-common phenomenon, and in many cases a legal one. As insurers shrink the number of providers they contract with to participate in their networks to save money and crack down on the nation's growing medical expenditures, consumers are more and more likely to inadvertently encounter an out-of-network provider and get balance-billed in the process. Last year, a Consumers Union survey found that over a two-year period, 30 percent of those with private health insurance received a surprise medical bill. In 2008, BusinessWeek estimated consumers paid at least $1 billion in balance-billing charges annually, a number that has almost certainly grown substantially. Since that time, after all, out-of-pocket medical costs for households with employer-provided health insurance have increased by more than 50 percent.