The Patients First Health Care Package in the Maine Legislature would make much needed changes to protect Mainers like me from facing medical debt because they are unknowingly referred to an out-of-network doctor.
Last year, my daughter needed medical care. She went to an in-network primary care provider who referred her to a local specialist. A few months later, she received a $9,500 out-of-network medical bill. Nobody told us that the specialist she was referred to was not in her plan’s network.
Patients should be given the information they need to make informed decisions about their care. To me, that is just common sense. This is why I urge policy makers to pass the Patients First Health Care Package sponsored by Senate President Troy Jackson, House Speaker Sara Gideon and state Sen. Ned Claxton. This package would help take a closer look at addressing rising health care costs by protecting Mainers from abusive billing practices and surprise out-of-network bills, and by making sure that people don’t find themselves with unexpected and expensive bills because they were unknowingly referred to an out-of-network provider.
Last February, my daughter was in excruciating pain and went to the walk-in clinic at her local health center, which was covered by her insurance. The primary care provider was unable to treat my daughter and referred her to a local specialist. There was never any discussion about which specialist she would see. Neither my daughter nor I — the person responsible for her insurance — were consulted or even informed that there were alternative options for the provider she was referred to. We had an HMO health plan that required services to be coordinated by a primary care provider, including any referrals. So when the primary care provider referred my daughter to a specific specialist, we followed her instructions.
At the time, my daughter was in so much pain she could barely sit, sleep or even use the restroom. Fortunately, the specialist successfully treated the underlying condition that was causing her pain, and within a few days she was on her way to recovery. Unbeknownst to us however, my daughter had been shuffled to an out-of-network provider.
From start to finish we were on a fast-moving train, focused on the goal of abating my daughter’s excruciating pain, but little did we know we would receive a $9,500 bill for out-of-network services from the specialist to whom we were referred.
Had we been informed that the specialist was not in her plan’s network, we would have taken it upon ourselves to request an in-network provider.
Given the urgent nature of my daughter’s medical needs and because we were not provided sufficient information, we found ourselves facing insurmountable hospital and provider bills.
I’ve spent many days and countless hours trying to resolve this issue. I have spoken to many employees at the health center, including staff in the referrals department. My understanding from speaking with health center leadership is that this type of oversight has happened before and will likely continue unless it is addressed.
I know from reading articles and listening to news stories that Maine has a partial surprise billing protection law. While I am pleased that this law exists, I believe that more needs to be done.
The Patients First Health Care Package includes L.D. 2111, An Act To Establish Patient Protections in Billing for Health Care, sponsored by Sen. Claxton. This bill would ensure people are notified if they are referred to an out-of-network provider. By giving people the information they need to make critical decisions about their care, this bill could help Maine families avoid thousands of dollars in unexpected charges.
It is time our medical system put patients first. Maine policymakers need to continue this work on behalf of health care consumers and commit to passing laws to protect us.
Brenda Bonneville is a business owner in Belfast and a member of the Belfast City Council.