We’ve all been there.

You try and pop a wheelie to impress your girlfriend and instead fall off your bike and bust your head.  Or, perhaps you wake up in the middle of the night with a sharp pain in your side and a raging fever.  A dull knife and a slippery onion.  Black ice.  Sometimes, you don’t even remember what happened – only that you’ve woken up in the emergency room.

This is one of the reasons why people have insurance – to protect them from the unknown, and the crippling costs associated with it.  But, it seems that more and more that protection that insurance offers seems to be riddled with holes.  Or rather, fine print.

 The Daily News has been covering a series of stories about New Yorkers just like you and me who have been hit with unexpected medical bills, despite having full coverage insurance.  The culprit? Misinformation about who and what is considered “in-network.”  Often, even if a patient goes to a hospital that is considered in-network, the doctor who they get treated by might be not be part of that network.  Even patients who are able to call their insurance beforehand to check their benefits aren’t always given up to date information.  What’s worse – patients have no way of knowing who or what their insurance will cover until months later when the bills start to arrive.

New York’s Department of Financial Services is now working hard to crack down on this issue.  The department has opened up an ongoing inquiry to investigate these “surprise” bills and the lack of accurate information given to people by insurers and medical providers.  In short, they want to know why it’s so hard for patients who try to stay in-network to actually do so.

If you’re in this boat and are feeling like you’ve been duped – don’t lose hope.  There are still a couple of things you can do:

• First and foremost, you can call Community Health Advocates (CHA), New York’s statewide consumer assistance program.  They can help you figure out why you’re getting medical bills and often help to get those bills resolved or reduced.  And you won’t get any extra bills – CHA works for free.  Give them a ring, toll free, at 1-888-614-5400.
• If you think you’re insurance company is in the wrong, you can also file a complaint with the Department of Financial Services, who also has a Consumer Assistance Unit.  Click here to file a complaint.

To learn more about this issue, check out the two recent Daily News articles:

•  “Surprise, surprise! Patients who think their medical care is covered get hit with huge out-of-network bills” (Daily News, 1/28/12)
•  “Hospital bill shock: Insurers’ fine print can hike costs to the sky.” (Daily News, 2/5/12)