FILE- In this Feb. 9, 2018, file photo, a radiology technician looks at a chest X-ray of a child suffering from flu symptoms at Upson Regional Medical Center in Thomaston, Ga. A nasty flu season and fresh insurance deductibles may combine this winter to smack patients around the country with expensive medical bills. (AP Photo/David Goldman, File)
FILE- In this Feb. 9, 2018, file photo, a radiology technician looks at a chest X-ray of a child suffering from flu symptoms at Upson Regional Medical Center in Thomaston, Ga. A nasty flu season and fresh insurance deductibles may combine this winter to smack patients around the country with expensive medical bills. (AP Photo/David Goldman, File) Credit: David Goldman

A family walks into a restaurant. There are no prices on the menu, but they do have a gift card from that restaurant and use it to pay for the meal. Everyone’s happy and the family goes home.

Six months later, the family gets a bill for $10 for “place setting services.” It seems some members of the restaurant’s staff were off that night and the tables were set by independent contractors, but nobody told the family it was going to cost them extra to use the plates and napkins provided.

Welcome to the world of “balance billing.” It’s not a problem for restaurant patrons, of course. But it is a problem — and a very expensive one — for hospital patients and anyone covered by a health insurance plan. It’s a deceptive practice and it must be stopped.

Here’s how balance billing works: A person requiring medical care visits a hospital. Before the visit, the person makes sure the hospital is part of her insurance plan’s network. But at some point during that visit, the patient unknowingly receives care from an “out-of-network” medical professional — often it’s an anesthesiologist, radiologist or pathologist; sometimes it’s the emergency room physician — who has been contracted by the in-network hospital to provide a particular service or to ensure reliable staffing levels.

The patient’s insurance covers the in-network costs, of course. But she’s still liable for the out-of-network charges, and those charges always come as a surprise — after all, the hospital is in the network, right?

According to a 2016 study in the journal Health Affairs, almost 10 percent of all inpatient admissions — and 20 percent of emergency room admissions — result in an unexpected bill for the patient. And those surprise bills can easily total thousands of dollars. According to the Kaiser Family Foundation, for example, a New York-based study showed the average out-of-network radiologist bill was $5,406.

Alice Peck Day Memorial Hospital in Lebanon began using physicians employed by a Colorado-based medical staffing company called EmCare for its hospitalist and emergency services in 2016. As part of that contract, however, APD required that its patients would not be balance billed. “To our knowledge, EmCare has kept that commitment,” APD spokeswoman Kelli Pippin said.

But EmCare, which says it employs some 16,000 clinicians in more than 4,600 health care facilities nationwide — although not at Dartmouth-Hitchcock Medical Center, spokesman Rick Adams said — has a well-documented track record of saddling patients with unexpected medical charges. The company was featured in a report in The New York Times last year headlined “The Company Behind Many Surprise Emergency Room Bills,” and a 2017 Yale University study found that out-of-network billing rates by hospitals jumped 81-90 percentage points after contracting with EmCare. The Yale study also determined that patients at hospitals that have contracted with EmCare are much more likely to have physician services coded using the most high-intensity, high-paying codes — which contributes, of course, to the overall growth of health care costs.

EmCare has called the Yale study “fundamentally flawed and dated” and said it “misled the public and our patients.” But the study and the Times report also led to a congressional inquiry into EmCare’s parent company, Envision Healthcare Corp., and a lawsuit by investors concerned about its billing practices.

In New Hampshire last year, a legislative committee formed to study balance billing recommended a series of options, and legislation is now being considered in the House that seeks to address at least some of the problems. A bill, HB 1809, would prohibit balance billing for those who receive anesthesiology, radiology, emergency medicine and pathology services at an in-network hospital, and responsibility for straightening out any discrepancy between the in-network and out-of-network charges would be placed where it belongs: on the providers and the insurance companies.

Balance billing is a shady shell game that takes advantage of people when they are highly vulnerable and adds a layer of complication to a health care billing system that is already unconscionably complex. HB 1809 isn’t a cure-all, but it won’t hurt patients a bit.