By Julie Appleby
After Pam Durocher was diagnosed with breast cancer, she searched her insurer’s website for a participating surgeon to do the reconstructive surgery.
Having done her homework, she was stunned to get a $10,000 bill from the surgeon.
“I panicked when I got that bill,” said the 60-year-old retired civil servant who lives near Roseville, Calif.
Like Durocher, many consumers who take pains to research which doctors and hospitals participate in their plans can still end up with huge bills.
Sometimes, that’s because they got incorrect or incomplete information from their insurer or health-care provider.
“It’s not fair and probably not legal that consumers be left holding the bag when an out-of-network doctor treats them.”
Sometimes, it’s because a physician has multiple offices, and not all are in network, as in Durocher’s case.
Sometimes, it’s because a participating hospital relies on out-of-network doctors, including emergency room physicians, anesthesiologists and radiologists.
Consumer advocates say the sheer scope of such problems undermine promises made by proponents of the Affordable Care Act that the law would protect against medical bankruptcy.
“It’s not fair and probably not legal that consumers be left holding the bag when an out-of-network doctor treats them,” said Timothy Jost, a law professor at Washington and Lee University. Jost said it’s a different matter if a consumer knowingly chooses an out-of-network doctor.
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