Millions of Americans are being confused by unclear billing practices and are in effect paying medical bills that they do not owe on. To make matters even worse, in some cases they are feeling pressure from collectors or providers to pay on certain expenses.
This is typically occurring when an insurance plan will pay for less than what a hospital, doctor, or lab service wants to be paid for a medical bill. The healthcare provider then is demanding the balance of the bill directly from the patient. The person does not need to pay this amount, and in some states this is being regulated or may even be illegal for the medical provider to demand payment. Fearing the calls of a debt collector, and uncertain what to do, the patient often times pays up without asking for help. Find how to get help from medical debt collectors.
Most Americans do not realize this, but unfortunately this is a common practice by providers. It is known as balance billing, and is often is illegal. When a hospital or doctor thinks that a health insurer has reimbursed too little for the work or service that was done, federal and state laws will generally bar the medical providers from asking, and especially pressuring medical patients to pay the difference in the medical bill. Instead, the hospitals and doctors should be negotiating and wrangling directly with the insurers for the unpaid bills and debt, as those are the parties that need to pay.
Patient advocates and economists estimate that consumers are paying more than $1 billion a year for which they are not technically responsible for paying. The California Association of Health Plans, which a trade group that is in Sacramento, has estimated that almost 2 million policyholders, just in California, have received such medical bills in the last two years, and the total mount of over $500 million was paid out when it should not have. The group found that 56% of consumers paid the bills.
Balance billing will most frequently occur with medical providers that participate in a managed-care network. It can occur from a doctor, dentist, or maybe even a pharmacy. It is more common for these providers to believe that the plan's insurer is giving too deep a discount on the medical bills or that the insurer is taking too long to pay a bill. So they try to then charge the patient.
Most state laws require medical providers to seek payment for a bill only from the insurer for any services covered by the plan. Many states will also protect insured patients from balance billing practices by all out-of-network doctors and hospitals in emergencies, since the patients usually do not control what doctor of hospital treats them in those situations.
If this happens to you, do not pay the bill. Instead, you should contact an attorney, call a medical billing advocate, or contact your state regulator for help with understanding your medical bill and your rights. Each state has different laws and rules in place, but in almost every single case the consumer will not be responsible for paying.
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