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balancing billing of medicaid members examined

Business Week Examines Practice of Balance Billing by Medical Providers
from kaisernetwork.org: Health Policy Daily Report
Business Week on Thursday examined how “millions of confused consumers” are being asked by hospitals to pay the remaining balances of medical bills not covered by their insurers, even though the practice, called “balance billing, often is illegal.” Balance billing can occur when “medical providers participating in a managed care network believe the plan’s insurer is imposing too deep a discount on medical bills or is taking too long to pay” and demands the balance from the patient, according to Business Week.

Forty-seven states ban in-network providers from billing insured patients more than their required copayment or deductible and federal law prohibits providers from billing Medicare beneficiaries for unpaid balances. Some states also ban additional charges for insured patients who seek care from out-of-network providers and emergency departments. While national statistics on the practice are unavailable, economists and patient advocates estimate that consumers pay at least $1 billion annually for medical bills that they are not legally responsible to pay.

Some providers across the nation have faced lawsuits because of the practice but many states “have been slow to take action in billing disputes,” and many “[c]onsumers, overwhelmed by medical bills,” often “lack the resources to fight balance billing on their own,” Business Week reports

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