For Steve and Ruth Myers, the hospital visits were the easy part.

What wasn’t so easy to deal with were the costs that came afterward — and not because the St. Joseph couple couldn’t pay but, rather, because the pile of bills led to a plethora of phone calls as they tried to understand the unexpected charges they’d been dealt after needing treatment on several occasions for unrelated conditions.

Because the Myers have a health savings account and, therefore, a high-deductible insurance policy, they expected their bills to be high until they met their deductible. What they didn’t expect were the out-of-network charges they received, despite the fact that Heartland Health is an in-network provider for their insurance company, United Health, or the balanced billing on their statements — which left them to pay whatever their insurance company wouldn’t.

“Because we went to a network provider, we assumed they would have to agree to the price the insurance company gave,” Mrs. Myers says. “We’re not blaming the provider for charging their price, but that does put us in the middle.”

Now, the Myers hope bringing their billing frustrations to light will help others recognize that the medical services they’re provided — at Heartland or elsewhere — won’t necessarily be covered by their insurance, even if the hospital itself is an in-network provider. And even if a hospital has a plan in place for dealing with such discrepancies, as Heartland says it does, problems that arise in processing bills might not be caught before patients are dealt charges they shouldn’t be.

In the couple of years since they took out their policy with United Health, the Myers have experienced this with bills from Heartland’s emergency department, ambulance service and radiology and pathology contractors. And after many phone calls, they learned that — like most other hospitals throughout the United States — Heartland contracts out its emergency, radiology and pathology services to providers that are encouraged, but not required, to accept the insurance policies it does.

For the Myers, this explained the out-of-network charges they’d received but also created a host of new questions.

“We have been told by one contractor that they should have a choice about whether to be a network provider,” the couple wrote in a statement explaining their experience. “This is true. But what choice do we have when we go to a network provider and they contract exclusively with non-network providers? If the primary entity, in this case the hospital, is a network provider, what is the incentive for subcontractors to join the network if they have exclusive contracts for work?”

Someone the Myers say was especially helpful in enabling them to understand the situation behind their bills was David Bruns, practice manager for Radiology Specialists of St. Joseph, PC. The problems the Myers have run into are uncommon, he says, and — when they do occur — usually are due to human error. He notes that this was the case with their radiology bill and that it is being reprocessed.

The Myers’ insurance company is reprocessing an emergency room bill, as well. But the hope they now have to receive some of their money back has come only after countless phone calls, which have reinforced the feeling of being caught between their healthcare and insurance providers. They also feel that they likely aren’t the only ones who have dealt with this situation.

“If I thought it was us only, we’d handle it” without speaking out about it, Mr. Myers says. He adds that he and his wife don’t wish to assign blame to anyone but would like to offer suggestions for guarding against other situations like theirs. They think Heartland should either require its contractors to be part of the networks it is, refuse network coverage if its contractors will not comply or send X-rays, labs, etc. to alternative contractors that are within the network of the insured.

“We feel like we’ve received good service at Heartland and that our insurance should pay a fair price,” he says. “But we don’t know what a fair price is, and we shouldn’t have to pay the difference in what they fail to negotiate ... The consumer is stuck in the middle, and who is advocating for us?”

The Myers are planning to change insurance providers, and if there’s any good that’s come out of all of this for them, it’s that they at least know now what questions to ask when choosing a new policy. This is a lesson that everyone can take away from their experiences, notes Dottie Bray, process leader for patient access at Heartland.

“Be informed,” she says. “Be educated. Understand the benefits of your plan. It’s a message of accountability — that it’s best to ask questions up front instead of waiting until the bill comes.”

Lifestyles reporter Erin Wisdom can be reached at ewisdom@npgco.com.