Complications of out-of-state insurance

Health insurance can be complicated, especially when the patient does not have the time or ability to verify network coverage (e.g. an emergency). KFF Health News published an article about one person's challenge with paying for treatment for a heart attack that occurred out-of-state. The patient was covered by Florida's Medicaid program, but the hospital, in South Dakota, sent the bill to the patient, not Medicaid. The hospital spokesperson said that the hospital did not bill Medicaid because the hospital is not enrolled as a provider with Florida Medicaid (a hospital representative noted that "Due to the significant credentialing requirements of our multiple hospitals and hundreds of physicians we do not participate with all states.") The patient tried to send the bill directly to Medicaid, but the Florida Medicaid program that he is enrolled in only processes bills sent directly from providers. The article reports that there is no federal law to require that providers send their bills to Medicaid.

The patient ultimately saw his bill entirely covered by the hospital's charity care program. However, that outcome only occurred after a journalist became involved. When the patient previously called to discuss the bill, it appears that charity care was not offered. While this case resolved favorably for the patient, it is easy to imagine how others may have to spend much more time and money and still get worse results.