Balance Billing Does Happen!

 In Group Health Insurance

balance-billing

Balance Billing

Surprise! Medical Bills!—also known as balance billing — occur when you receive a bill from a hospital, health care provider, or doctor who isn’t a part of your provider’s network. These out-of-network providers have not agreed to treat members of your network for discounted fees. This leads to higher rates for you.

But Why?

Some individuals may become confused by these bills, not realizing that even under plans that cover out-of-network providers you are expected to pay the difference for what the provider charges and what your plan covers. In a couple of words this is called balance billing. Preferred providers are the only ones who cannot bill you for health care provided.
Like most things in life, there is an exception to this rule. Generally, you aren’t required to pay any balance-billed charges if you receive out-of-network care in a true emergency situation. What you pay to the provider will go towards your overall deductible, however. Should your charges exceed $500, you can request mediation. Of Course our account managers here at Healthcare Consultants are always here to help with any claims.

Network is Key

The costs individuals have to cover for out-of-network balance billing is quite startling. Unfortunately, it’s a common occurrence. One national survey revealed that 11% of privately insured individuals used out-of-network care in 2015 alone. Out of those claims, 40% were related to emergency medical care and resulted in involuntary expenses.
The best way to avoid surprise balance billing is by choosing providers that are part of your network coverage. You can use your plan’s preferred provider directory, if applicable, to find and use doctors who are a part of your network.

What You Can Do About A Balance Bill?

If you receive a surprise bill in the mail, there are several things you can do.

  • You can call the doctor or provider and discuss your concerns.
  • Check your bill thoroughly to see if any added charges are there.
  • Contact  Healthcare Consultants, Inc. for assistance
  • If your bill exceeds $500 you can seek out mediation to reach a payment agreement.
  • File a complaint about your balance billing.

Balance billing doesn’t have to happen to you. By staying within your plan’s network, you can save yourself the heartache of receiving an unplayable bill.

Contact Healthcare Consultants, Inc. to learn ways to avoid these charges and to help you if you encounter them.

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