Woman Billed for Out-of-Network Doctor at Her In-Network Hospital

A North Texas mother is searching for help after she was surprised with a huge hospital bill. Even though her hospital was in-network, it turns out her specific doctor was not.

When Axelle Brown welcomed the newest member of her family, Colton, she had taken all the steps: picking the right doctor, hospital and birthing classes, and making sure it was all within budget.

"One of the first questions they asked me is, 'Do you want anesthesia?' And I being a first time mom, I said yes," Brown said.

But when she left Baylor All Saints Hospital with her bundle of joy, she didn't know she'd also be bringing home some serious unexpected debt.

"I get a bill a few months later for almost $6,000, which was shocking to me because I was at an in-network hospital," she said.

Brown's hospital visit was covered. But when she decided to get an epidural for the extra pain, they sent in a doctor to do it who wasn't on her insurance plan.

Her insurance paid part of the bill, but the nearly $6,000 that was left had to come out of her pocket.

"I'm a teacher. I don't make very much. This bill is more than I make in two months. I called them and was crying on the phone with them," Brown said.

The surprise bill is not unique to just the Brown family. In the NBC 5 Responds Consumer Investigative Center we've logged more than dozen calls from people in North Texas with similar stories from different hospitals and insurance companies across the Metroplex. Their hospital visits were covered but specific doctors who weren't.

"I don't know if it's the hospital, the insurance company, the anesthesiologist, I don't know what it is," Brown said.

Her insurance company, Aetna, says it does pay a set amount, but in Texas, out-of-network doctors have the right to charge more.

In a statement, Aetna said, in part:

"We have long supported legislation that prohibits out-of-network providers from billing patients at outrageous rates."

Baylor All Saints, where Colton was born, said navigating the health-care system is complex and it has processes to help when the unexpected happens.

And Northstar Anesthesia, the doctors who sent the $6,000 bill, said they've been working with insurance companies, and now 80 percent of patients at Baylor are in-network, and in the next 45 days 99 percent of patients will be covered.

So what happened to the Browns should go away for other mothers, and thanks to NBC 5 Responds, it goes away for them, too. Northstar Anesthesia agreed to reduce Brown's bill to only $170 after we stepped in to help.

"This shouldn't be a surprise to people. If you go to a in-network hospital, it should be an in-network doctor. Your insurance should cover it. It shouldn't be thousands of dollars," Brown said.

Here's what you should know:

  • Be in touch with your insurance company. Don't be afraid to walk in with a smartphone and ask the doctors for their specific name, company, and whether they take your insurance. You can always call your insurance company and ask them as well.
  • The type of doctors whom some experts say you should triple-check are anesthesia, emergency room and radiology doctors.
  • It's all tough to do in an emergency, but it will help you know ahead of time if the guy reading the X-rays that day is in fact about to send you a big bill.
  • Baylor also has some advice for navigating insurance coverage issues on their website.
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