Balanced Billing. This is a term you are going to want to get to know! In a nutshell, balanced billing is when your provider has the opportunity to bill you for an outstanding balance after your insurance company has covered its portion of medical expenses. What this also means is that out-of-network doctors who are not bound by in-network negotiated rate agreements can bill patients for the entire remaining balance not covered by insurance. These bills can be hefty to say the least! That’s where the new law surrounding limited balanced billing comes into play.
Limited Balanced Billing refers to a monetary cap that is put on remaining balances not covered by insurance. The new law states that patients cannot be charged more than the equivalent of in-network fees.
- Let’s say you needed a certain procedure done and due to certain circumstances, the procedure had to be done out-of-network.
- The out-of-network fee was $20,000 but the in-network fee was only $5,000.
- Under this new law, after insurance has paid its portion, the out-of-network physician can only charge you an additional $5,000 since that is what the in-network fee is for the exact procedure you had done.
One other very important part of the law concerns out of network provider charges when you are in a hospital or a facility of some kind. Say you have a procedure done at an IN NETWORK facility and the facility uses some one that was out of network. In the past you could be billed for the out of network providers fee. Due to this law you may not have to pay that fee. It is very important to specify to everyone that you want only in network providers. I like to write it on the paper when I sign for the procedure. I write “in network providers only”. This way you have some proof of your wishes. In addition, I also take a picture of the paper I signed so I can use that as proof. Just so my lawyer friends don’t yell at me…..I’m not giving legal advice here, I’m just saying what I do.
When receiving medical bills, it is important to scrutinize your bill and understand what you are being charged for and what is considered in-network versus out-of-network. Compare these charges to your medical plan coverage to make sure you are being charged fairly. If you have questions about your bill, advocate for yourself. Call your insurance company and get your questions answered.
Do you have questions about health insurance, your coverage, and how to get the most out of your plan? Let’s chat…I can help! (813) 391-3448