EXCLUSIVE: Settlement reached in ER doctor billing dispute - Hawaii News Now - KGMB and KHNL

EXCLUSIVE: Settlement reached in ER doctor billing dispute

HONOLULU (HawaiiNewsNow) - Alyssa Mendoza and her husband got hit with a hefty bill for emergency room care for their daughter.

 "Over $1,100," she said.

The ER doctor at Kapiolani Medical Center for Women & Children was not in health plan provider HMAA's network of participating physicians, so the Mendozas got charged for the doctor's services. Alyssa said she should have been told up front.

"At least make that information, knowledge, voiced to the patient that, 'Hey, I noticed you have this insurance. I'm not participating. Would you like a different physician?'" she said.

Turns out it wouldn't have made a difference. All of Kapiolani's ER doctors are connected to the mainland doctors group Emergency Medicine Physicians. Patients were caught in a contract dispute between EMP and health insurance company HMAA, so EMP billed the patients.

"I had to file an appeal with HMAA, send EMP my explanation of benefits, and I'm on standby with both," Mendoza said.

After North Shore couple Sumner and Tina told Hawaii News Now about their $871.73 bill, other HMAA subscribers complained on our Facebook page that EMP billed them hundreds or thousands of dollars for ER doctors services at Kapiolani.

"I didn't go in thinking that that was even in the realm of possibility. I have insurance," Tina said.

In a statement to Hawaii News Now, HMAA accused EMP of overcharging Sumner and Tina by more than doubling their bill.

"Until we can reach an agreement with EMP that is reasonable and fair, we recommend our members visit urgent care centers or other emergency rooms," HMAA said.

That meant don't go to Kapiolani for emergency care. Pali Momi ER is also staffed by EMP physicians.

"I just think that people need to be careful, always making sure that they're covered," Sumner said. "In this kind of situation it's kinda tough to make sure."

"You just want your child to get the care that they need," Alyssa Mendoza said.

In a statement Thursday, HMAA announced an agreement with EMP. HMAA said it will reprocess all claims with EMP for members affected by the contract termination.

"In addition, we will retroactively reimburse all member claims as if the contract never expired at the agreed upon rates. We will be reaching out to our members to make sure that those who have made out-of-pocket payments above their normal co-payments or deductibles are fully reimbursed," HMAA said.

That should help the Mendozas and many others who were wrestling with an emergency expense they never expected.

HMAA wrote a written response to the agreement reached with EMP. It reads: 

To Hawaii News Now,

HMAA is pleased to announce that Emergency Medical Physicians (EMP) has agreed to accept HMAA's original contract offer. EMP is an integral part of our provider network and has always treated our members with the highest level of care available.

We will be reprocessing all claims with EMP for members affected by the contract termination. In addition, we Will retroactively reimburse all member claims as if the contract never expired at the agreed upon rates. We will be reaching out to our members to make sure that those who have made out-of-pocket payments above

their normal co-payments or deductibles are fully reimbursed.

We apologize for any inconvenience this contract termination may have caused our members and we thank Hawaii News Now, Jim Mendoza, and the Garber family for bringing visibility to this issue. HMAA believes their efforts bring to the forefront the

ongoing challenges within the health care industry, and begins a critical dialogue about the true costs of health care. The rising cost of health care affects everyone in Hawaii and it is important for HMAA, the provider community, and our members

to work together to understand why health care cost are increasing, and how we can better manage those costs.

Sincerely,

HMAA


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