Balance billing in healthcare is back in the limelight. An article published by NBC News highlights the experience of a Colorado patient who received a surgery at an in-network hospital, but the surgeon who operated on her was out-of-network. The result was a “surprise” bill, which ended up with a collection agency after it was not paid. The collection agency filed a lien on the patient’s home and began garnishing the patient’s wages.

Balance -- or "surprise" -- billing refers to the practice where healthcare providers request payment from patients for the difference between the cost of the medical services provided and the amount covered by the patient’s insurance company.

Several states have taken the initiative to protect their residents from receiving these surprise invoices. States that have already enacted balance billing laws include:

  • Arizona -- law went into effect at the end of December 2018.
  • New Jersey -- law went into effect in September 2018.
  • Texas -- law went into effect in September 2017.
  • Oregon -- law went into effect June 2017.

A few similar bills have been introduced on the federal level, such as the End Surprise Billing Act of 2019 (H.R. 861) and No More Surprise Medical Bills Act of 2018 (S.3592).

insideARM Perspective

This problem is bigger than all of us, especially as it relates to emergency procedures. Patients deserve to know how much they will have to pay out-of-pocket for medical services. Doctors and hospitals deserve to get paid. Collection agencies should be able to pursue legitimate unpaid bills through respectful and legal means. Insurance companies should be able to comprehend their true risk as they calculate premium rates. The complexity associated with the need for all points of contact to understand who will pay what for whom and when -- often at a moment's notice -- is mindboggling.

I'd be very interested to learn the impact of the balance billing legislation enacted in recent years. Will the fact that it's illegal to send a balance bill force more doctors to take more insurance plans? Will there be unintended consequences? 


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