As the name suggests, balance billing occurs when you are billed for the difference between the provider’s charge and the allowed amount. Balance billing is often referred to as surprised billing as most recipients do not know the bill is coming until it arrives in their mailbox.
If you receive an unexpected medical bill, you may believe that your only option is to pay the balance. However, this is not always true. In some scenarios, you may be able to fight balance billing. Balance billing is illegal in some states, meaning you will not be legally required to pay the bill. You could have also received the bill in error. When this happens, you will need to speak with your healthcare provider.
Steps to Fight Against Balance Billing
Patients are often confused when it comes to billing practices. In many cases, balance billing is illegal and you may not be responsible for a medical bill if you are asked to pay the balance due between the amount the insurance paid and the cost of the medical care.
So, why does balance billing occur? When a doctor or hospital believes that a health insurer has reimbursed for too little of the service performed, state and federal laws will generally bar medical providers from asking patients to pay the difference. Instead, these providers should negotiate directly with the insurer for the unpaid bills.
Here is a look at how to fight balance billing and how you can prevent balance billing issues in the future.
1. Review the Bill
Billing departments in hospitals and doctor offices handle countless insurance claims on a daily basis. It is no surprise that errors occur from time to time. Your bill may have the wrong date on it or include services that you did not receive. You may also notice that your healthcare provider has the wrong insurance information for you. This is why you should always carefully review any medical bills that you receive in the mail. If you are not sure about something written on the bill, do not be afraid to ask questions. Keep the bills in a safe place and when you have time, contact your provider and ask questions.
2. Ask for an Itemized Billing Statement
When you receive a bill from your provider, each service and its associated price should be listed individually. This makes it easy to review the services listed and pinpoint any that you were charged for but did not actually receive. If the bill you receive is not itemized, contact your provider’s billing department and ask for an itemized bill. If you discover items on the statement that concern you, ask questions. For example, you may find that you were charged twice for the same test or scan. You also want to ensure that you were not charged for items that should be included under the facility fee, such as gloves or blankets.
3. Document Everything
Many people make the mistake of forgetting to document everything about their healthcare. While you may remember what services or treatments you received and whether or not they were covered in the present, over time this information may become unclear. By having a detailed healthcare log, you can refer back to your notes and compare your information to the data printed on your medical bills. Having documentation can also be useful if you have to dispute something found on your bill with your insurer or provider. You will also want to keep track of any communications that you have with your provider’s billing department or with the insurance company. Keep all of these documents together in a safe and easy-to-access location.
4. Communicate with Care Providers
It is important to stay in touch with your healthcare provider if you receive a medical bill that you believe was sent in error or that is excessively high. With an itemized bill in hand, call the hospital or the provider’s billing department and ask about the item in question. You may find that the billing department is not willing to work with you and you may need to call your insurance company directly. Contacting the insurance company is often required if they declined to cover a service that you know is covered by your policy. You can also ask your insurance company to negotiate with your healthcare provider for a lower rate. This can help ensure that you are not responsible for the entire bill if you find out you must pay.
5. File an Appeal with Insurance Company
If all else fails, you have the option of filing a formal appeal with your insurance company. If your appeal is denied, you can also go through the state insurance regulator for help addressing a balance bill. Look closely at your medical bill as it will often contain the information you need to make an appeal. You will also want to call your healthcare provider to notify them that you are disputing the bill with your insurance company. Request that they do not send the bill to collections although they may still do this if you fail to pay and the bill becomes overdue or delinquent. To dispute a medical bill, you will need documentation of the services that you received and their cost. You can often obtain these from your doctor’s office.
Contact BBG to Help Prevent Balance Billing
When fighting balance billing, you want to be well-informed about what your policy covers including details pertaining to deductibles, coinsurance, and out-of-pocket maximums. Also, familiarize yourself with the balance billing laws in your state. Today, only about 20 states have laws in place that protect consumers from balance billing practices to some degree.
Working alongside an experienced insurance broker can also help prevent balance billing. The knowledgeable insurance brokers at the Business Benefits Group can walk you through the process of fighting balance billing and help you determine if a bill was possibly made in error. For more information about balance billing, contact BBG.