Beware of Medical Balance Billing

Sometime we got the bill from medical service provider asked us to pay the for the rest of balance after our co-pay and our health insurance paid. We thought we owe them and begin to write a check to pay. Wait. Let review your Explain of Benefit (EOB) first. You should pay only the amount your heath insurance said it's your responsibility or you pay out of pocket. You should NOT pay the amount your medical service provider bill you. For example, medical service provider charged $70. The pricing agreed between your medical service provider and your health insurance was $42.45. Your health insurance paid by check to your medical service provider in the amount of $22.45. Your responsibility to pay was $20, not $47.55.

The article from Business Week: Medical Bills You Shouldn't Pay reinforce what I did few years ago. This is a must read article.

Some states ban Medical Balance Billing.

Idaho State Insurance Fund:

The Idaho Legislature passed a bill during the 2006 session intended to define balance billing under the workers compensation statute and to clarify that balance billing is not permitted.

The legislation, which amended Title 72-102, states that "balance billing" means charging, billing, or otherwise attempting to collect directly from an injured employee payment for medical services in excess of amounts allowable in compensable claims as provided by rules promulgated by the Industrial Commission.

Ohio Department of Health - Medicare Balance Billing:

The Medicare Balance Billing Program works to protect Medicare beneficiaries from being billed by health care practitioners for amounts beyond those approved by Medicare. The program investigates complaints and takes action against those practitioners who violate the law.

From New rules may stop hospitals from billing insured patients:

New regulations will soon prevent doctors and hospitals from billing patients when their health plan doesn’t pay enough to cover their bills for emergency room care, a practice that hammers unsuspecting patients but helps providers recover millions.

The regulations by the state Department of Managed Health Care that ban the controversial practice of “balanced billing” are expected to take effect by Oct. 15 if approved by the Office of Administrative Law and not stopped with a lawsuit.

The new rules, more than five years in the works, make the practice illegal and allow state regulators to take action against providers who bill insured patients.