It started as a medical emergency and ended as a billing nightmare.
Suzie Enterlin of Palm Harbor slipped on a wet bathroom floor and hit her head hard. "I decided I should go and get it checked at the emergency room cause it was a rather large bump," said Enterlin.
Her husband, Marty Enterlin, took her to Mease Countryside Hospital in Safety Harbor, an in-network hospital on their Coventry health insurance plan. Her emergency room visit lasted a few hours and included a cat scan and other various tests. Fortunately, Enterlin was not seriously injured.
The Enterlins say they expected to be charged a $200 co-pay for the emergency room visit, as spelled out in their insurance plan. However, they did not expect a separate bill for the emergency room physician who treated Suzie Enterlin.
The physician's bill totaled $1,368. After Coventry paid its share, Enterlin's portion was $711. Why? The explanation of benefits showed it was because the emergency room doctor was billing at an out-of-network rate.
That did not sit well with the Enterlins. They were confused because the hospital was an in-network facility. "I said when I'm taken to the emergency room, I don't have time to interview the doctor, are you in network or not?"
Enterlin says, "It's not the fact that it's $700. It could be $2. It's the principle of it."
When Eight on Your Side contacted Coventry Health Care on Enterlin's behalf, the spokesperson confirmed Mease Countryside Hospital is an in network facility but the doctor who treated Enterlin is out of network.
However, when Coventry took a closer look at the claim they found a billing error on their end. Turns out, the physician in question uses an out-of-state billing service and Coventry based Enterlin's claim on that out-of-state zip code.
Once they determined the error, Coventry changed the zip code and charged Enterlin the in-network rate which dropped the amount the Enterlins owe the doctor from $711 to $120.
The Enterlins say it's a good lesson to share with others. It reinforces why consumers should take a very close look at their medical bills and question anything that seems out of line.
Enterlin says, "I keep asking myself how many people are just paying this bill without questioning it."
The Mease Countryside Hospital spokesperson says it contracts with physician groups to provide emergency room doctors. And, although, the hospital encourages those groups to align with the hospital when it comes to insurance companies, they can not require it.