State Efforts to Protect Consumers from Balance Billing

By Jack Hoadley, Kevin Lucia, and Maanasa Kona

The 115th U.S. Congress released multiple proposals to combat the problem of balance billing—a practice that arises when insurance covers out-of-network care, but only reimburses the provider for a portion of the charges and the provider then directly bills the consumer for the difference. Consumers are most likely to receive these surprise medical bills from health providers outside their insurance plan’s network after receiving emergency care or medical procedures at in-network facilities.

While a federal solution could offer a more comprehensive approach to protecting consumers, it is important to note that several states have taken action to protect consumers from balance billing. In their latest 50-state review for The Commonwealth Fund’s To the Point blog, CHIR’s Jack Hoadley, Kevin Lucia, and Maanasa Kona discuss how at least 21 states have taken some steps to address balance-billing concerns, with 9 of these states offering comprehensive protections to their consumers. You can read the full post here.


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