According to a national survey released by the nonprofit Kaiser Family Foundation back in January, as many as one out of every five working Americans with health insurance are currently having problems paying off their medical bills.
Curiously, the survey determined that much of the reason for this is balance billing, a phenomenon that involves patients receiving surprise medical bills from hospitals and/or providers who do not have a contract with their health insurance plan.
By way of illustration, consider a person who undergoes a planned surgical procedure that they are informed will be covered by their health insurance only to later receive a bill from the attending anesthesiologist who they learn has no contract with their provider.
According to experts, the recent explosion in balance billing, which can result in thousands of dollars in charges, can be attributed to the proliferation of so-called “narrow network” insurance plans, which, in exchange for lower monthly premiums, provide members with access to fewer hospitals and physicians.
While members of HMOs are protected from balance billing in limited circumstances under state law, this is the full extent of the legal protection currently offered to Floridians.
Interestingly enough, however, the state House of Representatives recently passed a billthat would essentially end balance billing altogether by:
- Requiring hospitals and medical facilities to inform patients ahead of time as to whether the services of out-of-network physicians will be utilized and that they may bill separately
- Prohibiting out-of-network physicians from billing patients for emergency room care, or covered surgery or procedures at in-network facilities beyond the amount paid by their insurance
While the bill has considerable support in the medical community and among health insurers, there is concern that it is now heading for defeat due to a last-minute amendment in the Senate.
This amendment would essentially prohibit insurers from denying claims for certain covered parties, a move supporters say is designed to offset the loss of bargaining power — and income — for specialists like anesthesiologists and radiologists who frequently utilize balance billing.
It will be interesting to see if the bill ultimately passes before the end of the legislative session.
Stay tuned for updates …
If you are currently struggling with medical debt, it’s important to understand that you are not alone and that there are ways to secure a fresh start. Indeed, a skilled legal professional can guide you through all of your options for securing relief and answer all of your questions.