What is balance billing?

Balance billing occurs when in-network insurance providers bill insured patients beyond co-payments or co-insurance required by the plan. While co-payments, co-insurance and deductibles are factored in to the equation, no additional billing should occur. Unfortunately, it’s become commonplace and what many patients and consumers don’t understand is that it is also illegal in most states and with regard to Medicare.

How to recognize balance billing

In most situations, patients will receive an additional bill after their doctor or hospital has settled up with their insurance company. Unfortunately, many of these additional bills simply lump procedures together instead of itemizing the exact costs that are being charged. According to a news report from CBS Evening News, patients who receive these bills often don’t know what to do or where to turn for help. One woman featured in the report had back surgery and paid the necessary deductibles and co-payments relating to the surgery. She assumed that the matter was resolved and returned home to recuperate. However, shortly afterwards, she received an additional bill from the hospital for $60,000. She, like many others, simply couldn’t understand what was happening. Although her case is ongoing, she ultimately contacted a medical billing advocate to obtain additional information about the bill and discovered that nearly two-thirds of it constituted over-billing.

What to do if you receive a balance bill

If you receive a balance bill, don’t assume that you must pay it. Most medical facilities have adopted a Patients’ Bill of Rights that outline the kind of information patients have a right to receive and outline how disputes should be resolved. Contacting the medical facility, the State Attorney General’s Office and an experienced attorney whose practice focuses in this area of the law are all options available to anyone who receives a medical bill for the “balance” of services rendered.