Have you been a victim of Molina’s surprise billing for emergency room or anesthesiology care? Or, surprise billing by any insurer in Washington state or Oregon or anywhere? I would like to hear from you as I am in conversation with attorneys regarding a class action case.

Here’s my story…

Swedish is in Network with Molina Healthcare, Sort Of

Swedish Hospital is in network with Molina. Molina pronounces this. Swedish pronounces this. And, Molina trains third party insurance agents who guide consumers to select their plan on this fact. But none of Swedish’s anesthesiologists are in network and neither are emergency room physicians at its Ballard location. Molina does not cover these costs. This is called surprise billing or balance billing.

But Molina and Swedish Seem to Have a Scam Going

Early in the morning on March 26th, 2019, I went to the emergency room at Swedish Hospital in Ballard. Molina sent me two explanation of benefit documents, one for fees to Swedish Hospital, part of which I had to pay. And the other for the Ballard Emergency Physicians (BEP) which it said I had to pay entirely.

Molina assigned $567.24 of the Ballard Emergency Room bill to me

But Swedish appears to employ out of network BEP doctors to cover its emergency room everyday despite advertising on its website that its hospitals are in network with Molina.

Why do I suspect this? I went to the Swedish Ballard emergency room five months later on August 17th and Molina again sent me two explanation of benefit documents for that visit, expecting me to pay BEP directly.

Molina assigned $1,373.21 of the Ballard Emergency Room bill to me from August.

Swedish Appears to Run its Ballard Emergency Room with Out of Network Physicians

And also, the BEP website seems to say it runs the Ballard emergency room.

“…a highly skilled private Emergency Medicine group serving the growing community of … Swedish Medical Center – Ballard Campus.”

Molina and Swedish do the same thing for anesthesiology.

Earlier this year, Swedish’s media relations team told me that Swedish works only with an anesthesiology provider that is also out of network with Molina, and you can’t bring your own to the hospital (BYOA :).

Molina publishes a list of anesthesiologist providers consumers can see, but this list omits any mention of Swedish. There is no actual declaration that Swedish’s anesthesiologists are out of network.

In both cases, Molina separates the billing for Swedish for these out of network providers pushing the costs on to you.

All of this is likely a violation of consumer protection laws and other law. Molina misled us, instructing us and its agents that Swedish is in network in order to sell us an expensive health insurance policy. In my case, my premiums are $7,837, my deductible another $2,925 and my out of pocket maximum, $5000. In other words, I’m on track by the end of the year, to have spent $12,837 on my health insurance just for in network care.

My annual costs for healthcare through Molina will be greater than $12,852.43.

If you have experienced this, I would like hear to from you.

In Closing

In 2018, I was the lead plaintiff on a technology class action case, Reifman et al. vs. Canary Connect, Inc. And again this year, I am in conversations considering a class action case, this time in healthcare.

If you have paid surprise healthcare bills in the last seven years to out of network providers at in network facilities, I would like to hear from you.

A likely indicator of a surprise bill is one of the CPT codes 99283, 99284, and 99285 as you can see on my Molina’s Explanation of Benefits.

If you have any other questions, please contact me or post them as a comment and I will do my best to respond.

Postscript, Health Insurance 2020

Lastly, the only two political candidates that support eliminating private for profit corporations from the health insurance system are Bernie Sanders and Elizabeth Warren. The remaining democrats kowtow to the health insurance lobby.

If you’re voting Republican at any level, you’re propping up a corrupt for profit health insurance system for yourselves and your children; please reconsider your vote.

Posted by Jeff Reifman

Jeff is a technology consultant based in the Pacific Northwest.

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