Surprise! You Have Medical Coverage Gaps

From the Huffington Post (Dr. Bose):

Surprise coverage gaps occur when an ED patient reasonably believes that they are having an emergency, are treated by the ED and then discover after the fact that their health plan does not provide fair coverage for the services that were provided to them or their family member. One common coverage gap is that the patient’s health plan will reimburse the physician at or about Medicare levels—leaving a large “balance”, or difference, between that “allowable charge or rate” and the clinician’s charges or the “balance bill”, particularly where the clinicians were “out of network” (OON), which of course the patient has no control over.

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