Balance billing occurs when a patient is billed for the difference between the hospital’s or provider’s charge and the amount allocated by the insurance company. Also known as surprised billing, this practice can leave medical patients confused about why they are being asked to pay, and overwhelmed at the prospect of having to cover a potentially sizable medical bill.
To prevent balance billing, it is important to understand your costs prior to undergoing procedures. Keeping detailed records of your medical services and bills can prevent paying for that which you are not legally required to pay.
Ways to Protect Against Surprise Billing
There are two main instances in which balance billing usually occurs.You can experience balance billing if you receive emergency care at an out-of-network facility, which means you saw a provider or hospital that was not covered by your insurance policy. You may also receive a balance bill if you receive elective non-emergency care at an in-network facility but unknowingly see an out-of-network provider that works in the facility. Because your insurance company does not have a contract with any out-of-network service provider, your insurance company will likely not cover the entire medical billing.
Currently, there is no federal law that limits the practice of balance billing; however, there are many states that have introduced laws to protect patients from the effects of balance billing. If balance billing is not legal in your state and you receive a bill from your provider or hospital, contact your provider or facility and tell them that you believe that you were wrongly billed. In most cases, you will not be responsible for paying the balance, instead, your insurance company must pay the out-of-network provider or the facility directly. You may only be responsible for any in-network cost-sharing, such as copays, deductibles or coinsurance.
Only Go to In-Network Medical Providers & Hospitals
Prior to any procedure or new appointment, confirm that the provider(s) take your insurance and your particular plan. It is also important to remember that even if one provider in a facility takes your insurance, it does not necessarily mean that all providers in that facility will accept your insurance. For example, if you are having surgery you may find that your surgeon takes your insurance but your anesthesiologist does not. You might not realize this until you receive a bill in the mail for anesthesia services.
If you are planning on seeing a new provider or are visiting a new hospital or facility, ask ahead of time whether they accept your insurance. If you plan to visit an out-of-network provider, ask your insurance company how much you will be responsible for paying. In some cases, an insurance company will still pay for a percentage of the services. In other cases, you will be solely responsible for any charges. When scheduling any type of health appointment, confirm that the provider you are scheduled to see, is in your network.
Never Rely on Directories
Many major insurance companies have online directories that provide a list of providers in your area that accept your insurance. Unfortunately, they can be incorrect or outdated. It is not uncommon for healthcare providers and hospitals to change the type of insurance or plans that they accept; when this happens, the changes may not be reflected in the directories. Other information on directories may also be incorrect, such as phone numbers, addresses, or other relevant contact information; confirm information obtained online.
Though it may be a less convenient option, making a phone call directly to the provider or facility is the best way to determine if a particular provider or hospital takes your insurance and plan. Confirm again when you arrive for your appointment.
Keep Detailed Records
Staying organized is key to avoiding surprise medical bills. Without a trail of documentation, it can be difficult to determine what services you have already been billed for and whether or not these services were already paid for in part or in full by your insurance company. Sometimes a provider will make a mistake and send you two bills for the same service or send a bill for services that you did not receive. When you have the proper documentation to show these mistakes, you can easily clear them up with your provider.
Recordkeeping should begin even before you receive services. When you schedule a procedure, ask your provider for a detailed cost estimate. This can be a valuable resource if you are forced to appeal a medical billing. It can also be helpful to jot down any notes regarding what services you will be receiving, which providers you will be seeing, and any other noteworthy information that could relate to your final medical bill. If possible, ask your provider for dated documentation confirming that they accept your insurance and keep this in your records.
Know Your Rights Against Balance Billing
Balance billing is handled differently in states across the U.S. It is important to be aware of what states offer these protections or ban this practice altogether. If you receive a balance bill in the mail, know your rights. Contact your provider or hospital to see if you are actually responsible for the bill and if needed, negotiate to have your bill waived or the fees lowered. To learn more about how to stop surprise medical billing or for help with employee benefits like health insurance, speak with the experts at Business Benefits Group.