15 Feb Hospital Patients Should Be On Alert for "Balance Billing"
A close relative in my family completed a week-long hospital stay in November, 2008. It is now mid-February, and just about every day, a bill arrives from the hospital, a doctor’s group associated with the hospital, or a vendor that provided some product or service. In addition, both Medicare and the private health insurance company are sending out a blizzard of paperwork, most of it indecipherable and internally contradictory.
Basically it is pretty much impossible to know what your insurance carrier is obligated to pay, how Medicare (if applicable) applies and whether the hospital and/or associated providers has the right to bill you.
Now, there is another potential issue that could muddy the waters even further. Many hospitals engage in what is known as “balance billing.” This happens when a hospital is in an insurance network, but anesthesiologists, pathologists, radiologists and emergency-room physicians at that hospital are not on the network. A recent story in the Ft. Worth, Texas Star-Telegram reports on this phenomenon.
These out-of-network providers do not have any agreement with the insurer for “discounted” fees and they can and do demand full price from the patient. This procedure allows insurers to avoid paying higher reimbursement for “in-network” services and it allows medical providers to collect full price rather than a discounted insurance company rate.
Often the patient does not discover that his ER doctor or radiologist was not on network until months after the procedure. And even if that patient has a suspicion that non-network providers are being used, often hospitals may not have any “in-network” providers available for the patient to use.
Some states are examining the “balance billing” procedure and are putting legislative limits on the practice. Perhaps it should be no surprise that politicians are looking to nationalize health coverage. Short sighted and greedy practices by insuers and hospitals will lead to a government takeover of their industry.
Jonathan Ginsberg, Esq.
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