Balance Billing

There is a controversial practice known as balance billing, health care providers have been going after patients for money they do not owe. I have experienced this first hand and all it took was a couple of phone calls to make the bill disappear.

Balance billing occurs when your insurance plan covers less than the health care provider wants to be paid. The hospital, doctor or lab demands the patient pays the balance. The trouble is, more often then not, the patient doesn’t have to pay the balance and in some cases the practice is illegal.

In my case, the hosptial bill was $245 for an emergency room visit at Falmouth hospital in Massachusetts, my insurance company paid $170 and I was sent a bill for the remaining $75. My first reaction was to write a check for $75 and be done with it, but then I remembered reading an article about this practice and I decided to call the hospital to inquire about the bill. The hospital billing representative said my insurance company paid $170 and I was responsible for the rest, I then decided to check with my insurance company. What do you know, my insurance company said the hospital was “in network” and the hospital had to accept the “contracted rate”, which means the hospital had to accept the amount my insurance company was willing to pay and couldn’t bill me for the rest.

45 states ban “in network” providers from billing insured patients for the balance and federal law bans health care providers from billing Medicare patients for unpaid balances. Unfortunately, most people don’t realize they are NOT responsible for the balance and don’t take the time to inquire. Thankfully in my case the bill wasn’t that much but imagine paying hundreds, thousands or ten of thousands of dollars that you don’t have to? Many states also don’t require patients to pay balance bills to doctors or hospitals in emergency cases, the thought being you can’t control which provider you see during an emergency.

So the next time you receive a bill for a medical procedure check with you insurance company to see if you are responsible for the balance.

CBS News recently reported on balance billing.

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