Medical Providers Using “Balance Billing”
Medical providers such as hospitals, doctors, or other healthcare providers have a practice called “balance billing.” Balance billing is when a medical provider bills the patient for the difference between the providers charge and the allowed amount by the patient’s own health insurance. This is typical for out of network physicians, who are not bound by a contractual “in network” agreement which gives them the ability to bill the patients for the entire remaining balance.
The first instances when balance billing occurs is when a health provider charges more for a service provided than what the health insurance company allows. For example, a provider may set their own charge for a service at $150, while your health insurance provider only allows up to $100 for that specific service. The provider may then turn around and bill you the remaining $50 which your health insurance did not cover. The second instance when balance billing occurs is when, a patient receives medical care by a provider who is believed to be “in network,” but it later turns out the medical provider is not “in network”.
Texas Department of Insurance Provides Protections
The Texas Department of Insurance (TDI) has a consumer protection program that is helping people with surprise medical bills. A Texas law has allowed many consumers to seek mediation when their balance exceeds $500. As stated in their website “If you were surprised to get a bill form a doctor, hospital, or other health care provider that isn’t part of your health plan’s network, we might be able to help.”
According to the Texas Department of Insurance, balance billing complaints are up 1,000 percent in Texas. Over the last few years, the balance billing complaints have risen significantly from 112 complaints in 2012 to 1,334 complaints in 2015.
Beyond seeking help with the Texas Department of Insurance, another option consumers have is to try to negotiate with the medical provider themselves. Many providers provide payment plans and will agree to provide discounts if you pay in cash immediately.