By: Jack Hoadley, Kevin Lucia, and Maanasa Kona
This year has seen increased reporting on the issue of balance billing and a flurry of state-level action to solve it. Balance billing occurs when patients who are covered by insurance seek medically necessary care from out-of-network providers either due to an emergency or because an in-network facility used the services of an out-of-network provider. The insurer will often limit its payment to an amount it determines is fair and the out-of-network provider may bill the patient for the difference. The 2019 legislative session saw five states move towards protecting their consumers from this practice, bringing the total number of states with protections in place up to 27.
In their latest post for the Commonwealth Fund’s To the Point blog, CHIR’s Jack Hoadley, Kevin Lucia and Maanasa Kona take a closer look at the protections against balance billing enacted by the latest set of states to tackle the issue and find that state approaches to solving this problem are evolving. However, the researchers also find that despite this progress, there is still a need for federal action because (1) 23 states and the District of Columbia still lack protections, and (2) only federal law can apply balance billing protections to employer-sponsored insurance, which covers the majority of Americans. You can also find state-by-state information on balance billing protections in our new interactive map.