“Balance Billing” Can Be Illegal and You and
Your Employees Should Not Pay.

Economists and patient advocates estimate that consumers pay $1 billion or more a year for which they are not responsible. As healthcare costs continue to soar, millions of confused consumers (your employees!) are paying medical bills they don’t actually owe. Typically this occurs when an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid. The healthcare provider demands the balance from the patient. Uncertain and fearing the calls of debt collectors, the patient pays up.

Balance billing most frequently occurs when medical providers participating in a managed-care network believe the plan’s insurer is imposing too deep a discount on medical bills or is taking too long to pay. California, New Jersey, and 45 other states ban in-network providers from billing insured patients beyond co-payments or co-insurance required by the plan. Similarly, federal law prohibits providers from billing Medicare patients for unpaid balances.

NOTE: There are times when balance billing is appropriate and legal. If an employee uses non-participating providers, your employee may be required to pay the balance of the medical bill.

HOW DOES THIS AFFECT YOU AS AN EMPLOYER?
Your employees may be overwhelmed by medical bills and lack the resources to fight balance billing on their own. National statistics are not available, but there is little doubt that many employees unwittingly fall victim to balance billing. The California Association of Health Plans, a trade group, estimates that 1.76 million policyholders in the state received such bills in the past two years totaling $528 million. The group found that 56% paid the “balance billing” bills. Patients think they owe this money, and it causes tremendous stress and anxiety for people. Balance billing can occur from routine office visits to acute emergencies that bring an employee or a family member to the hospital.