Balance Billing Can Involuntarily Cripple a Budget After an Emergency

Balance billing is the act of passing on the difference in cost between what a medical provider charges and what insurance will pay to the consumer.

If an insured person diligently ensures that all their providers and hospitals are “in-network,” according to the terms of their health insurance policy, that difference should be non-existent once the annual deductible and visit copay are considered.

But even very attentive consumers have been surprised with outlandish balance billing following services such as ambulance transport, emergency room visits, or even planned outpatient procedures.

The reason for this is that a consumer can only research so much. There is a lot of behind the scenes activity in the world of professional medicine that cannot be controlled by an individual.

A person can make sure that they have a contracted relationship to a doctor that is considered “in-network” and that admits to a hospital that is also in-network. They can make arrangements with specialists that are in-network, and arrange minor surgical interventions with in-network facilities.

Patients, however, cannot control how the institutions staff their own facilities.

There is a trend for medical centers to contract out emergency room services to doctor’s groups that may or may not have the same pre-negotiated financial agreements as the facility itself with certain insurance companies. In other words, some or all of the emergency room physicians can be out-of-network within an in-network hospital.

This often results in unexpectedly inflated balance billing for the patient. In some situations, it may not just be emergency room personnel either. It could be a random anesthesiologist, pathologist, or radiologist that is contracted to work in an otherwise in-network hospital.

The manner in which one surgery is billed to a patient is frustrating in the best insurance pay-out scenario. Most often, there will be a bill from the hospital, a bill from the surgeon, a bill from the anesthesiologist, and frequently a pathology or lab bill.

All of these bills demand to be paid in full within a short period of time unless a payment plan is allowed and set up. This is a drain on any family’s budget.

Now, let’s assume the in-network hospital has contracted an out-of-network radiologist that read the presurgical X-rays prior to the surgery. The patient receives services without informed consent by proxy.

It is becoming more and more common for the patient in this situation to receive balance billing from the out-of-network provider in this scenario that is excessively high, surprising them with expenses that are beyond their resources to pay. This is a hospital administrative choice whose consequences are being pedaled off to the vulnerable consumer.

Another balance billing issue that also needs to be considered is situations in which the patient has absolutely no ability to engage in forethought or research – a true emergency.

As an example, imagine a 38-year old female has a seizure at work. Because of the employer’s liability insurance, an ambulance has been called, but the transport service is out of network.

She is taken to the nearest out-of-network hospital. She is in a post-seizure brain fog and unable to direct the medical personnel. She will likely be presented with sizable balance billing from the ambulance company, emergency room doctors, and hospital should she be admitted. She had no ability to make a choice in this situation.

If you have experienced a similar situation and received high medical bills after being unknowingly treated by an out-of-network provider, you may be able to participate in a legal investigation.

Join a Free Surprise Medical Bills Class Action Lawsuit Investigation

If you received a bill from an out-of-network doctor after being treated at an in-network hospital, you may qualify to file a surprise medical bill lawsuit or class action lawsuit. It’s absolutely free to take part in an initial consultation, so act now!

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