OAKLAND (KPIX 5) -- Health insurance is supposed to help pay your medical bills, but that's not how it worked for a young dad with a top-tier insurance plan who went in for a scheduled procedure he was assured was covered.
Jeremy Weintraub had every reason to expect his insurance, Anthem Blue Cross, would cover his inguinal hernia procedure at the Alta Bates Summit Medical Center in Oakland. After all, before the operation, he says the admissions staff hospital told him: "Yes, the surgery was authorized, yes, the surgeon was network." But, what they failed to tell him, was that even though his in-network surgeon has an office at the Oakland facility, the hospital itself is not in Anthem's network.
Something, Weintraub learned days after the procedure, when he received a bill from Alta Bates for more than $20,000. "My insurance wasn't going to cover any of the (hospital) bill," Weintraub recalled. "It seemed like a weird sort of game that I didn't know the rules for."
"It's not a rarity," said Linda Adler, a medical billing specialist and founder of Pathfinders Medical. She says no matter what the hospital or doctor tells you, nowadays it's up to patients to confirm if everything from hospitals, procedures, lab tests even anesthesia is covered by their plan. "Consumers shouldn't need to ask that, but in our universe the way the game is played you have to ask everything," Adler told Consumerwatch. "When you go to the hospital to have a medical procedure, you really have to play defense."
She says that includes price-checking. For example, the comparison site Health Care Blue Book lists the total fair price for Weintraub's hernia procedure at about $5,000. That's one fifth of what Alta Bates charged.
A representative for the hospital issued this statement to Consumerwatch: "Health care can be confusing and that is why we encourage patients to talk to their medical providers and their health plan to determine whether a procedure or facility is in network or out of network and what their out of pocket costs may be. The pricing for any given procedure is complex and includes multiple variables that are determined by a specific patient's needs."
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