health insurance

Out-of-Network ER Surgeon Leads to Surprise $34K Bill for Virginia Family

A family unknowingly let an out-of-network doctor treat their teenage son and wound up with a bill for tens of thousands of dollars.

Zack Hamilton, 17, of Falls Church, Virginia, broke his nose playing baseball when an inside pitch hit his bat then hit him in the face.

His father took him to the emergency room at a hospital he knew accepted their health insurance.

“The hospital said to them, ‘Lucky for you there's a plastic surgeon on call,’" said Zack’s mom, Elizabeth Hamilton.

A few weeks later, they received a bill for $34,000.

“At first I was like, wow!” Elizabeth Hamilton said. “I was confused, because we had already gone through the process of settling the bill with the hospital and I was like, what could this possibly be for?”

It was from the on-call plastic surgeon, who was out of network.

He billed the Hamiltons for the portion their insurance didn't cover — a practice called balance billing.

The Hamiltons assumed that since the hospital took their insurance, any doctor working there did, too.

“It's been a year-and-a-half; it’s been incredibly stressful,” Elizabeth Hamilton said.

She contacted News4, and while the doctor didn’t return our call, she said they reached a settlement on a much lower bill.

“There needs to be national change on this,” she said. “That would be ideal.”

She wants transparency from the hospitals to the physicians to health insurance providers so other families don't get caught up in balance billing, which almost drained the Hamiltons' bank accounts.

“Can we ask the hospitals, not only the hospital we saw but the other hospitals, to make us more aware of when we're seeing a doctor who is not in our network and what the outcome of that may be?” she said.

Currently, hospitals in are under no obligation to tell you what insurance an ER doctor accepts.

Go here to file insurance-related complaints in D.C, Maryland and Virginia

Contact Us