Balance billing can leave you with medical charges Q:I went to a local hospital emergency room where I was treated for pneumonia and admitted for one night. In all, the bill was more than $6,000. The ER doctor’s bill was $650. My insurance paid $468, and the doctor sent a bill for the remaining $182. When I called to complain, Iwas told the doctor didn’t accept my insurance. My insurance company first told me they paid him in full so I didn’t have to pay. They later backtracked and said because it was an emergency situation, they paid him as an in-network doctor even though he is not, but the doctor is able to charge me the difference.

When Gwendolyn Robinson of Goochland was laid off in February, it didn’t affect her alone. Her husband counted on the health insurance she carried through her work as a receptionist. They pondered their options: continuing coverage through a federal program, short-term insurance or going without. And then Milton Robinson Jr. got a blazing toothache.

While workers are being asked to cover more of their health costs, employers generally still pay the lion’s share of their insurance premiums. Employees of small businesses have access to fewer benefits than colleagues at large ones, a recent Small Business Administration study found. A Zoomerang survey of 98 Richmond-area small businesses last week found that 59 percent provide health insurance for their employees. Fifteen percent reported that the coverage cost their business 10 percent of sales revenue. Some reported that more than 15 percent of sales revenue went toward insurance.

For individuals and families facing unemployment and no insurance to cover health-care costs, there are several options. These include state and federal programs; free health clinics; clinics that provide care on a sliding payment scale; negotiating fees with doctors, hospitals or employers; and short-term or temporary insurance. A look at a few of the offerings:

Virginians who have lost their jobs in a wave of layoffs since September have a new lifeline for health insurance, but only if their former employers still have health plans and know about the obligation to offer continuing coverage. The federal stimulus package adopted in February will pay 65 percent of healthinsurance premiums for laid-off workers for up to nine months, while a newly adopted state law will offer the same opportunity for people cut by small businesses since the beginning of September through the end of this year.

The health insurance industry offered to stop charging women higher premiums, a surcharge that hits many self-employed working women trying to buy their own coverage. It was the latest concession from insurers as Congress works to overhaul the nation’s $2.5 trillion health care system to expand coverage and slow rising costs. Insurers are trying to head off creation of a government health plan that would compete with them in every state—something many Democrats favor but something the companies say would drive them out of business.

Virginia is one of eight states getting a grant of up to $1 million from the Robert Wood Johnson Foundation to enroll more children in government-funded health insurance. “This is great news for Virginia’s families, especially during these difficult times when many are losing their health insurance, leaving their children uninsured,“ Gov. Timothy M. Kaine said yesterday.

Gov. Timothy M. Kaine announced today that the state is getting $1 million in funding and support from the Robert Wood Johnson Foundation to increase the number of children enrolled in the health insurance programs known as FAMIS and FAMIS Plus.

Q:I have run in to two cases in the past two weeks where people lost their health insurance when they became unemployed, and they immediately looked to cancel important testing. What is the situation? Answer: People new to the ranks of the uninsured may be lost when it comes to finding free or low-cost resources to help them with medical needs. As a result, many might put off medical care. According to a poll by the Kaiser Family Foundation, 54 percent of Americans said they cut back on health-care spending in the past 12 months because of financial concerns.

Hopes are fading for help from the state for parents of autistic children, with legislators weakening a proposal that would require insurance companies to pay for treatments for the disorder.

When Doug Ashworth left his job last year as a firefighter because of health problems, he lost his health insurance. He had the option of continuing his insurance under his former employer’s plan, but he would have to pay the entire premium. “It was going to be $1,100 a month,“ said Ashworth. “When you lose your job and they want $1,100 a month for health insurance, who can afford it? You lose your job, you still have to make your house payment, car payment, utilities, and they want $1,100 a month?“

As president of Henrico County-based Streamline Timberworks, T.J. Daly looks for ways to save his company money. This year he saved more than $50,000—28 percent—by changing the company’s health insurance to nHealth. “There are three things that are unique about nHealth,“ he said. “They understand more than just insurance, they take out the complexity of managing [health-care costs] from both the administrative and employee perspective, and they have one-on-one interaction.“