By Jack Hoadley, Beth Fuchs, and Kevin Lucia
All privately insured consumers are vulnerable to surprise billing, or balance bills, for out-of-network care. These bills arise when insurance covers out-of-network care, but the provider bills the consumer for amounts beyond what the insurance pays and typical cost-sharing. Often this occurs even when the patient is careful to choose an in-network hospital and physician, but during the course of care an additional treating provider — an anesthesiologist, for instance — is out of network.
During the 116th Congress, at least six bills have been introduced to address surprise medical bills; four have bipartisan support. In their latest post for the Commonwealth Fund’s To The Point blog, CHIR experts analyze advancing federal legislation and share an updated comparison of key provisions. You can access the full post here.
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Five years ago I had kidney stones and went to the emergency room. My explanation of benefit said an emergency room visit copay was $50 and I paid $50. In March I had another kidney stone. My Florida Blue statement of benefit said $500 emergency room care benefit and $500 ambulance. after paying the copay, JAX Emergency Physicians billed me an additional $405 and another Physician billed me $300. I suspect balance billing. They are threatening to ruin my credit. I suspect they are guilty of balance billing. What protection do I have?