Balance Billing Bill Postponed Due To Hospital Opposition

     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 adult-career-clipboard-1919236 (1)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.

Have You Seen IRMAA On Your Medicare Bill?

     IRMAA stands for Income-Related Monthly Adjustment Amount, and what it means is that you are being charged more on your Medicare Part B premium and your Medicare Part D Drug Planmoneybag_graphic.jpgpremium.  How much more depends on your income.  If your Modified Adjusted Gross Income, or MAGI, is over $85,000 as a single person or over $170,000 as a couple, you will have this surcharge added to your monthly premiums.
     It goes up incrementally as your income rises to a high of an additional $325.00 on Part B and $77.40 for Part D if you are in the highest brackets (above $500,000 for individuals or $750,000 for couples).  The amount is added to the standard premium, $135.50 for 2019.  The good news is that it doesn’t affect what you pay for a supplemental or advantage plan.
     Only about 5% of people on Medicare pay the extra charge which was implemented on Part B in 2003 and on Part D in 2011 as a way to save the federal government money on the burgeoning cost of the Medicare program.
     What can be even more frustrating is that Medicare looks at income tax records from two years prior.  That means if you sign up for Medicare in 2019, your IRMAA will be based your 2017 tax records. 
     Most people are making less money once they retire and go on Medicare, so what can you do if you are in this situation?  You can appeal the extra charges to Medicare directly.  By filing form SSA-44, Medicare may adjust the amount you owe to reflect your current income levels.  If you don’t appeal, your income is re-evaluated yearly, so you won’t be paying the higher premiums forever if your income does decrease.