Should Surprise Medical Bills Be Banned?

Posted on September 5, 2016 at 12:00pm by
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A California woman recently made national news for being conned out of $18,000 in surprise medical bills through a process known as ‘balance billing’. The woman went to her doctor to receive an epidural nerve block, but was not informed that the assistant surgeon and anesthesiologist conducting her procedure were out-of-network. In other words, the doctor was covered by her insurance policy, but the other two specialists were not.

In-network providers under your insurance policy face limits for what they charge under the Affordable Care Act. Depending on the state, out-of-network providers may not be restricted by how much they can bill. A person may go to an in-network hospital, but receive treatment from an out-of-network health professional who can bill whatever they want. Patients would have to conduct extensive research before receiving treatment to avoid balance billing.

Consumer Reports claims one in four Americans have been harmed by balance billing. Several states are considering a ban or have already banned the practice. Florida recently passed a law against balance billing for both emergency and non-emergency treatment. California has banned balance billing for emergency treatment, and is now looking at legislation that would force insurance companies to reimburse out-of-network providers.

New Jersey is considering legislation that would require hospitals and doctors to inform patients if they are in-network before providing treatment. Many other states require mediation between hospitals and patients hurt by balance billing.

Balance Billing Continues to Be a Cause of Surprise Medical Bills

It is unreasonable to assume that patients have the time or resources to meticulously research every health professional who will be involved with their care. In some cases, it is not even possible to avoid being treated by health care workers who are out-of-network.

People being brought into hospitals for emergency treatment have no say in the matter. Can a car accident victim with a severe concussion and several broken bones pull out a smart phone and start researching hospitals or doctors in the area that are in-network? Of course not. In many cases, patients are left with excessive medical bills caused by circumstances beyond their control.

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