Balance billing is a common practice in healthcare where a patient is billed for payments not covered by their insurance because they received treatment from out-of-network providers. Assemblyman David Chiu (D-San Francisco) pulled a bill he introduced to the state Senate that would have prohibited out-of-network hospitals to bill insured patients for emergency services. It would also have put limits on charges for each service.
Jan Emerson-Shea, spokeswoman for the California Hospital Association, said that health plans would be less inclined to negotiate contracts with hospitals if the state imposed set prices for services. She maintained that if this provision were eliminated, the hospital association would support the bill. “That provision doesn’t need to be in the bill if the bill is really about protecting patients,” she said.
Chiu does not agree, fearing that without the provision, insurers would raise premiums to recoup their costs. “It is useless to protect patients from receiving a bill on the front end if hospitals can turn around and price gouge consumers on the back end. It’s like closing your front door and leaving the back door wide open,” he said.
To avoid these “surprise” bills, always check in advance with your health insurance carrier to make sure all the doctors involved with your surgery are in-network. Even though your hospital is in-network, it may contract with doctors who are not. Also, make sure any lab work you have done is with a facility that is in-network.
If you do receive one of these unexpected bills, there are still steps you can take to avoid or lower the payment. Many insurers will negotiate if you appeal the questionable charges. There are also billing or patient advocates who will step in to help you if you have questions concerning your bill. These advocates look for things such as duplicate or unusually high charges.