Health Care News Updates for May 2019

Surprise Bills”

Doctors’ Take on Breaking Healthcare News

Are you one of 30% of Americans that receive “surprise” medical bills you expected your insurer to pay?

Two major instances of a surprise bill

  1. When you receive treatment from an out-of-network (OON) doctor or facility that is not contracted with your insurance company.

An example: A patient is seen in an Emergency Department (ED) by a doctor who is not contracted (in-network) with the patient’s insurer. One in five ED visits are estimated to include care from an OON doctor whose charges may be 2 ½ times that of in-network doctors. Surprise bills from OON doctors and medical facilities can run into tens of thousands of dollars.

  1. If you’ve met your yearly deductible, have paid your co-pay and your insurance company has paid their required amount. In other words, your bill is paid in full, yet you erroneously receive a balance due bill.

What Government is Doing About Balance Billing

Half of the states technically prohibit balance (surprise) billing and/or make patients’ insurance companies cover the charge. But many of these states limit protection to emergency care provided to patients whose doctor is OON. States lack authority over the 60% of employer-provided plans that are self-funded.

While Congress tries to grapple with the complex problem of surprise bills, in the meantime, what you can do to avoid surprise bills:

  1. Whenever possible, before receiving medical care from a health professional or medical facility, make certain they are in-network with your insurer.
  2. In Instance #2 above, give your doctor or facility the benefit of the doubt. Call the billing manager to resolve the problem.
  3. Scrutinize itemized bills carefully for billing errors that are very common.
  4. Try to negotiate a reduction in what you may legitimately owe or request a payment plan. Consider enlisting help from a non-profit professional billing company, such as Access Project.
  5. If the above measures are unsuccessful, you can complain to your state’s insurance department.

For additional advice about balance billing see Insider’s Guide to Quality, Affordable Healthcare, pgs. 26-31.

If you have family and friends you think can benefit from please ask them to sign on.

The monthly healthcare forum for June will focus on what to do if your doctor(s) shows signs of burnout.

Leave a Reply

Your email address will not be published. Required fields are marked *