Balanced Billing Practices May Produce Unfair Surprise Medical Bills

Balanced billing is a serious problem the patient population faces when dealing with medical bills, especially for emergency room care. Most patients generally assume that if the emergency room they go to is within their insurance provider’s network, they providers who care for them there will also be in-network. They may be in for a shock when they receive an expensive medical bill that resulted from balanced billing.

Balanced billing occurs when there is a remaining balance from a medical expense that is not covered by the insurance provider. For example, if a blood test cost $250 and insurance only covers $100, then the patient would be charged $150 under balanced billing.

The bills can be much higher in the case of emergency room services, because patients can receive the majority of their care out of network in these cases. In cases of out of network billing situations, hospitals and other healthcare facilities often send bills to the patients directly and force patients to face the full brunt of the cost.

Patients are often taken aback when they receive these medical bills, which is why these bills are also called “surprise medical bills.” Surprise medical bills can also be produced from receiving care from an out of network doctor from typical healthcare checkups, in which case the patient is often unaware, or other emergency services like ambulance rides.

Regardless of how surprise medical bills are produced, many patients complain that they were not aware they were being subjected to balanced billing and were greatly impacted by the expensive medical costs.

Overview of Balanced Billing Allegations

A class action investigation has recently been launched against balanced billing practices, and other cases of unreasonably exorbitant surprise medical bills. This means that patients who received unreasonable surprise medical bills can potentially fight back, and dispute the legality of the charges and billing practices.

In a recent example of this, EmCare and medical group EDS-1 Practices of California faced a balanced billing class action lawsuit in 2017. According to the claim, the plaintiff had reportedly received medical care at an emergency room that was within her insurance provider’s network.

However, the hospital’s emergency room care staff was managed and provided on a contractual basis by EmCare and parent company EDS-1 Practices of California. Because of this, the claimant had reportedly received a surprise medical bill for over $4,000, which she says is over four times the average price the bill would have been if the medical staff had been within network.

Her bill was also almost double the amount of the average charges of out of network medical bills for the area the claimant was in. The claimant was eventually forced to file this balanced billing class action lawsuit to dispute the claims.

The balanced billing lawsuit alleges EmCare had failed to disclose the fact that treating physicians could potentially be out of network for patients, and that the medical bills would be the highest possible for the billing code in the area for emergency services.

“At the time of admission, EmCare made no effort to warn patients about what it knew to be true—that the emergency department physicians do not accept the same insurance as the hospital,” the balanced billing class action lawsuit states.

Join a Free Surprise Medical Bill Class Action Lawsuit Investigation

If you were hit with a surprise medical bill from an out-of-network doctor at an in-network hospital, you may be entitled to compensation.

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