The News-Star, Monroe, La., on balance billing

April 6
The News-Star, Monroe, La., on balance billing:
Most of us who’ve endured any major illness or significant medical procedure have gotten another surprise while we’re on the mend: an unexpected bill.
These bills are called “balance billing.” Generally, most physicians and hospitals have contracts with insurance companies that require them to accept the insurance’s “in-network” reimbursement as full payment.
But many emergency medical personnel or their companies, as well as many anesthesiologists, pathologists and radiologists, don’t have contracts with insurers. So in addition to whatever the insurance company pays, nothing prevents them from billing the balance to the consumer.
Three Louisiana lawmakers — Reps. Jim Fannin, R-Jonesboro; Alan Seabaugh, R-Shreveport, and Sen. David Heitmeier, D-New Orleans — have filed bills to correct this issue.
Among the changes the bills would require: Medical emergency providers to accept either the in-network reimbursement or bill the patient, but not both; prevent the medical providers from suing the patient for the balance; or reduce the percentage of the amount of the balance the patient could be billed.
Health insurance policies today require considerable due diligence on the part of the consumer. We must make sure we’re following the rules of our network, getting pre-clearance or referrals and attending to many other details that have made managing your health more complex.
Surprise bills for out-of-network services you did not know you were going to incur, such as for medical transportation, anesthesia, radiology or pathology, should somehow be regulated or monitored. For many families, these types of surprises can force them into serious financial problems and even bankruptcy.
No one expects these services to be provided gratis, but there should be upfront notification of what the charge will be if the consumer is expected to pay what the insurance company will not. And if the consumer has the choice of an in-network provider for these medical services, he should be able to make that choice.
There’s a lot of money at stake with these proposed bills and they already face opposition from physician and hospital lobbies.
But all parties should be concerned about taking financial advantage of consumers at a vulnerable time, and the Legislature should take this opportunity to consider this matter.
Online:
http://www.thenewsstar.com