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On May 29, this year, I broke my hip when a ladder slid out from under me and I was thrown to the cement floor of my barn. I ended up going to the emergency department at Kootenai Health in Coeur d’Alene, my local, in-network facility. I was treated and released by an ED physician.

Several weeks later I received the explanation of benefits from my insurance company and I discovered that this physician was not in-network (despite working at Kootenai Health) and I was charged the out-of-network fee for her services. This amounted to almost $500 out of my pocket. I am fortunate to have a medical savings account that allowed me to cover this charge, but if I hadn’t, I would’ve had to somehow come up with $500 to cover this bill.

Here’s what I think happened. KH did not have enough contracted physicians to cover the ED, so while actively recruiting new doctors they arranged for a group of physicians to take on those duties. If not contracted with Kootenai, this would result in an out-of-network charge for that physician’s fee.

It never occurred to me to question the provider whether they were in-network. I assumed that by going to my local, in-network hospital all my care there was covered and in-network.

Wrong. This is where my word of caution comes in. It is clear in health care today that you, as a patient, have to take on more responsibility with regard to your care. Now, it appears that you must ask (if your conscious and able) whether or not your doctor is in your network, despite the facility being so. Don’t assume they are.

To avoid these egregious charges that you might not easily be able to pay, it is best to err on the side of caution. Your wallet will thank you.

Michele Martin, RN

Coeur d’Alene, Idaho