Agents Fight Hospital Bill Surprises

A few years ago, providers and carriers showed some willingness to help clear up payment problems involving out-of-network specialists, but, today, carriers are being tougher in applying out-of-network rates to doctors, says CAHU President Jeff Miles.

Meanwhile, the doctors billing people usually refuse to negotiate, and the doctors often dont know and dont care about the problems, Miles says.

The controversy focuses on a practice called balance billing.

Insurers and other companies that organize provider networks usually persuade participating doctors and hospital to charge patients who belong to the networks standard, discounted rates.

Providers who sign the contracts agree not to go after patients for the balance of the bill that happens to be above the networks negotiated rate.

But providers who treat out-of-network patients usually have a legal right to balance bill the patients, or go after the patients for any amounts left unpaid by the insurers.

In many cases, hospitals, out-of-network specialists and health plans all fail to warn patients about the possibility that out-of-network providers might end up balance billing them, CAHU says.

Reproduced from National Underwriter Edition, May 28, 2004. Copyright 2004 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.