New Mexico Residents Overcharged or Denied “In Network” Coverage

samantha severyn
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Surprise! Your Insurance paid the ER bill but not the Doctor bill?!

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Pirl is interested in New Mexico residents that have made Emergency Room visits that may have been overcharged or were refused “in-network” billing from the following Counties: Cibola, Bernalillo, Santa Fe, Los Alamos, and Sandoval.

According to the Center for Disease Control and Prevention, “Each year, there are 41.9 emergency department (ED) visits per 100 people in the United States (US)”.

In a study done at Yale University, over 2 million emergency departments in the United States were investigated and it was found that 1 in 5 patients who went to ER’s within their insurance networks may be treated by “out of network” doctors, thus being cornered into surprise charges not covered by their insurance. Surprise charges unknown until it is revealed when the bill arrives - and it is too late to challenge the amount.

The study states, “out of network” doctors were paid 2.7-times what “in-network” doctors were paid for the same services. Researchers Zack Cooper and Fiona Scott Morton found that almost half of all Americans could not afford to pay these surprise charges without selling assets or borrowing money. Cooper and Morton's research analyzed data from a large insurer that covers “tens of millions of lives annually” to study the drivers of out-of-network billing for emergency care. “Our data covers nearly $28 billion in emergency spending on nearly 9 million ER episodes from 2011 through 2015”. 

"Most patients with health coverage go to in-network emergency rooms and rightly expect to be treated by in-network doctors," said Cooper, assistant professor of public health and economics at the Yale School of Public Health. In addition, Cooper stated "Our study shows that nearly a quarter of people who visited in-network emergency rooms were exposed to potentially major costs. This is just wrong and we must do better. People should not face financial ruin from medical bills they cannot reasonably avoid."

If you were in any way overcharged or denied “In Network” coverage at an Emergency Room, we may be able to help you get your money back!

Contact us today at (650) 762-8545 or fill out the form below! 

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