LOS ANGELES (CBSLA.com) — Surprise medical bills have become a crippling financial problem for thousands of Californians with preferred provider organization plans, or PPOs.

“I’ve always paid my bills. I had excellent credit,” said Nancy Gomez of Glendale.

But these days, Gomez knows better than to apply for a loan or new credit card.

“I’m just afraid that I’ll be denied and, quite frankly, I think I will,” said Gomez, who is saddled with thousands of dollars in medical debt.

Charges she never saw coming.

“I am a fully insured person,” said Gomez, who has a solid medical plan, one that let her choose top-tier doctors to fix her bad back.

“I paid extra to have a PPO insurance,” said Gomez, who initially chose treatment with an Encino pain specialist.

“I researched him, made sure that he was in my network,” she said.

And, in fact, he was. Her initial visit cost just what she expected: a $40 co-pay.

“The doctor was very nice and told me, ‘Yes, I can definitely help you,’ ” she said.

Gomez went in for an epidural nerve block and a few weeks later says she was shocked and devastated to get an $18,000 bill.

Though the bill is totally legitimate, Nancy Kincaid says, “it’s rather alarming.”

Kincaid is with the California Department of Insurance and explains that, under current law, “it is legal to get these bills.”

Here’s how it happened:

When Gomez returned for the injection, she says “they directed me to go to the second floor, where the doctor would perform the procedure.”

The problem, she says, “he went upstairs to his surgical suite and that made him an out-of-network provider.”

There is no limit on what an out-of-network provider can charge.

“Increasingly, we’re seeing consumers getting these surprise bills,” said Kincaid.

Gomez’s ordeal was far from over. The epidural didn’t work, so she scheduled surgery.

“I made sure that the surgeon, that the hospital, were in my network,” she said.

Her surgery was a success and while she was home recovering, she says, she got another bill.

“I get a bill for about $9,000,” she said.

But while Gomez was on the table, “apparently there was an assistant surgeon who did not belong to my in-network provider list,” she said.

What’s more, she was billed again, explaining: “unbeknownst to me, the anesthesiologist was also out-of-network. … It put me into incredible debt.”

Gomez is not alone.

Consumer Reports says one in four Americans have been blindsided by surprise medical bills, charges from out-of-network providers who participated in their care without disclosing their fees, often without their knowledge.

“You meet your anesthesiologist literally 15 minutes before you go under the knife,” she said. “Even if you were to ask, ‘Are you in my network?’ what are you going to do, stop the surgery?”

Assembly Bill 72 is currently being considered in Sacramento. If passed, it would ensure that patients pay only in-network fees if they go to an in-network hospital. Doctors who are out-of-network would have to settle extra charges with insurance companies, not patients.

Gomez hopes her story encourages lawmakers to take action.

“I ended up paying what I could and then I was sent to collection and to this day, that’s where I am,” she said.

Click here for tips on how to protect yourself from surprise medical bills.

Story produced by Gerri Shaftel Constant, the medical producer for CBS2/KCAL9-TV.

Comments (16)
  1. A guy says:

    Wouldn’t out of pocket maximums still apply here? They may be high, but they’re not 27K high…

    1. Nancy C says:

      Out of Network OOPs are very high. Although i have to say this does sound extreme…

  2. Same thing happened to me, only not for quite as much money.

    I was referred from the office to the procedure center for a breast ultrasound and biopsy. A few weeks later I was referred from the same doc to the same procedure center for a colonoscopy.

    The breast stuff was covered but the colonoscopy was not. I fought it for months, but then just gave up and paid. The whole thing sucked and now I’m afraid to get any more medical care becuse I don’t have room in my budget for these kinds of “supposedly covered” surprises.

    It’s not like you can price shop for that stuff.

  3. Penlope says:

    I am so sorry to hear this. Very sneaky and tricky of this doctor not to tell you this. I fell on the beach in Cambria a couple of years ago. Someone called the medics because I basically was in shock from the fall, but i was in recovery by the time the medics came. They insisted I go to the nearest hospital (30 miless) away even though I said, I’m staying across the street. I just want to go back to my room and lay down.” Finally they talked me into going to the hospital though all my vitals were fine and I had obviously not broken anything. I didn’t even hit my head, just fell on my butt. Anyway, I went and who knew, the ambulance is out of network. 3600 dollars for that ride. My insurance (out of state, I was a visitor in CA) only paid 700. The medical system in this country is a nightmare.

  4. gregg johnson says:

    Give us the names of the out of network trolling doctors.
    They need some unsocial networking attention.
    They may have given you some mouse-type agreements to not defame but attempts or the accomplishment of medical/administrative fraud should supersede and place them under the social medial spotlight.

  5. Kiljoy says:

    ROFL a I see after 30 years it still the same scam from every directions. Nothing has changed when it comes to bending patients over.

  6. Mook Fist says:

    I don’t see the problem here. The free market is simply charging what the market can bear. These things cost money. What, would you rather have the government run your health care like Canada, Germany, or UK where all their citizens are at huge disadvantages when it comes to their health?

    1. gregg johnson says:

      This is fraud. Especially when they don’t inform the patient. The doctor knows it. The doctor wants higher $$ than insurance is willing to pay.
      As far as medicine is concern, doctors are only practicing, they don’t have to get it right. Though the administration of medical care is very specific.
      Doctors who do this should be publicly shamed.

  7. Kevino says:

    This is the classic bait and switch, you’re covered until they knowingly move you to the other floor where you pay more. The state only covers so much and then they’re out of luck, with a person they can sue and ruin their lives. It’s fraud outright, but nothing has been set as a president yet.

  8. fotojennic says:

    “I ended up paying what I could and then I was sent to collection and to this day, that’s where I am,” she said. And that is exactly why she should have just not paid any of it. Think her credit is any better because she attempted to pay at first? nope. NO ONE should have to pay !! If they don’t get paid at all for those astronomical fees, maybe they’ll start charging a reasonable amount.

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