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.