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Many people who have been hit with surprise medical bills may be in a position to file a balance billing lawsuit.
A balance billing lawsuit stems from people who have stepped into an in-network hospital believing that they would get more or complete coverage by their insurance company, only to find out that some of the care they receive will be billed at out-of-network charges.
It is reasonable to believe that when you walk into an in-network hospital that the physicians you see are also in-network. However, this is not always the case, patients have come to learn.
Balance bills are also known as surprise medical bills that are sent to a patient. They include outstanding balances a patient owes once the physician has billed or received payment from an insurance company.
The reason why it is referred to as a “surprise medical bill” because a patient thinks that when walking into an in-network hospital that they are being seen by an “in-network” physician.
If you received a surprise medical bill from an in-network hospital after being seen by an out-of-network physician, you may be eligible to file a balance billing lawsuit.
Overview: Filing a Balance Billing Lawsuit
According to a study conducted by the Yale School of Public Health and the Yale School of Management, out-of-network billing issues affect more than 22 percent of patients admitted into U.S. emergency rooms. According to the Yale study, almost 1-in-4 ER patients also become treated with an out of network ER physician.
The unfortunate thing is that even when a patient does all their research to verify that their hospitals and physicians are in-network, there can still be out-of-network surprise bills. And the situation, unfortunately, is often out of the patient’s control.
This was the case for a Texas resident, Scott K., who became injured, suffering a broken jaw, during a violent attack that led him to an ER visit at Dell Seton Medical Center in Austin, Texas, according to Vox.
Although he did a thorough research to verify that Dell Seton was indeed an in-network hospital, and that it was covered by his health insurance provider, Humana, he wasn’t sure what else he could have done when he was seen by out-of-network ER physicians. He told Vox, “I couldn’t go home. I had a broken jaw in two places.”
Unfortunately, in many cases, anesthesiologists, radiologists, and ER physicians do not work directly for hospitals. Rather, they are employed by outside companies and these companies many not be contracted with the same insurance providers as hospitals.
Another scenario occurs when a patient believes he or she is being seen by an in-network physician at an in-network facility for a surgical procedure. However, as they are underway to undergo the procedure, they could be seen by an anesthesiologist who they presume is also in-network.
Unfortunately, the anesthesiologist may work at out-of-network rates, while the patient expects that their coverage will be at in-network rates. As a result, they end up receiving surprising out-of-network billing or surprise medical bills.
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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2 thoughts onPatients Frequently File a Balance Billing Lawsuit Due to Surprise Medical Bills
I need help with a balanced billing issue. My mother has QMB status and has been billed $960 that represents a co-pay for he stay in a Nevada hospital for kidney failure…she was visiting Nevada from Utah at the time of the event.
I knew she had QMB status so I wasn’t worried about the hospital being out of network.
Federal law is crystal clear that QMB patients are not legally obligated to pay co-pays yo providers.
The problem I’m having is who to talk to that can send the hospital a strong message to stop all billing or face sanctions.
I told them the bill will not be paid because Federal law prohibits providers from billing QMB patients any co-pays. The billing rep. said they will send the matter to collections.
My argument now is that the hospital is wrong and they indicated that they would send the matter to collections—is this not extortion?
My mother only has Social Security and is judgement proof since she has no assets, just Social Security.
How can I stop this nonsense? Is there a person who can stop this?
Thanks….
We sent our “balance billing” hospital a certified letter notifying them their hands were caught in the cookie jar so to speak. We provided copies of the QMB BILLING RULES under Medicare Part A and Part B cost sharing program. (see Sections 1902(n)(3)(B), 1902(n)(3)(C), 1905(p)(3), 1866(a)(1)(A), and 1848(g)(3)(A) of the Social Security Act [the Act]. Whereby it states Federal law bars Medicare providers and suppliers from billing an individual enrolled in the QMB program. Period!!!! Once we provided the hospital proof of our knowledge and verification of that knowledge we no longer received “balance billing” statements regardless of “disclaimers” they have on the back of billing statements. Federal law super cedes state government laws. Stand up for your mothers rights. If they retaliate…. That’ll be another cross for them to bear. Just saying….. Good luck!