Hospital-based physicians and pathology groups in Illinois are trying to overturn a new state law that prohibits some providers from “balance billing” patients.

“Balance billing” occurs when a health care provider receives a payment from a patient’s insurer, then bills the patient directly for the difference between the amount charged and the amount the insurer has paid. Insurers typically use provider contracts that prohibit in-network providers from balance billing plan members, but patients who see out-of-network doctors typically have no protection against balance billing.

Many consumers have argued that, no matter how hard they try to seek care in-network, they may have no control over whether the doctors they see while in an in-network hospital are in the network.

Illinois now has a new law that blocks providers of radiology, anesthesiology, pathology, neonatology or emergency room services from balance billing health plan participants who have sought care from an in-network hospital or an in-network outpatient surgery center. The law took effect June 1.

Lawyers at McDonald Hopkins L.L.C., Chicago, have argued in a suit filed recently in the U.S. District Court for the Northern District of Illinois that the anti-balance billing law is unconstitutional

In the suit, Peoria Tazewell Pathology Group S.C. et al vs. Messmore et al., the lawyers argue on behalf of two pathologists and three hospital-based pathology groups that the idea of applying balance billing restrictions to just a few types of physicians is arbitrary, unfair and unconstitutional. The plaintiffs contend that Illinois already had regulations controlling balance billing, and that the new law exists mainly to shift costs from the insurance companies to the providers.

- Allison Bell

Other balance billing coverage from National Underwriter Life & Health: