Ironically, we covered surprise ER bills pretty recently. Turns out there’s another way that folks are getting hit hard in the wallet after surviving an emergency.

Some people may not know this, but most physicians in the ER actually don’t work for the hospital. They usually work for a separate company that provides the doctors to staff the ER. So when you get a bill from the hospital, you should expect to get a separate bill from the doctor. Hospitals are pretty good at making sure that the doctors are in the same insurance networks as the hospitals. But what happens if you need some sort of specialty care while you’re there?

According to several recent studies, somewhere around 20% of the specialty providers who might provide services in a hospital are not in the same insurance networks. So how does this work out? Let’s say you go into the ER after a car accident. You’re hurt pretty bad, and they need to do surgery. You probably are going to have an anesthesiologist put you to sleep so you can get through it. Some of these surgeries require a neurosurgeon to monitor the progress so you don’t end up with permanent nerve damage. If these specialists aren’t in your insurance network, you could end up with tens of thousands of dollars in bills that the insurance company won’t even count toward your deductible.

So what’s a person to do? Unfortunately there aren’t too many good options here. Ancillary professional charges don’t get evaluated even in pre-planned surgeries where you get pre-approval from your insurance company. You still get stuck.

Of course there’s always bankruptcy to get rid of the debt, but that’s a drastic step for someone who otherwise has good credit and no debt problems. Some states, like Colorado for instance, have ‘bad faith’ laws about how insurance companies have to behave themselves and honor their commitments. I don’t know of anyone actually testing this approach with a surprise bill, but it might work. It shouldn’t take a lawsuit, though, to resolve this.

The New York legislature has run a bill addressing surprise ER bills, but it hasn’t been tested yet. They’re the only state to have done it too. This is a growing problem for more and more people as insurance companies narrow their provider networks. More states need to start looking at legislative solutions to this problem.

Surprise ER hospital bills are more common than you think

You might survive going to the emergency room — but the “surprise” bill you get later could be a real killer.