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Sha'Ron James


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Federal, state efforts to end balance billing: 4 things to know

News Article

April 04, 2016

Becker's Hospital CFO

As payers and providers battle over reimbursement rates for medical services, balance billing has been a hot topic at both state and national levels.

The practice of balance billing refers to a physician's ability to bill the patient for an outstanding balance after the insurance company submits its portion of the bill. Out-of-network physicians, not bound by contractual, in-network rate agreements, may bill patients for the entire remaining balance.

Balance billing leaves patients with unanticipated medical bills that can have detrimental financial effects.

Here are four things to know about the latest efforts to end balance billing.

1. In Florida, lawmakers recently passedlegislation that limits the charges patients receive when they have to use out-of-network medical providers, according to an article published by Consumer Reports. This legislationwas submitted to Florida Gov. Rick Scott March 30, and he has 15 days to sign or veto it, the article notes. The bill will automatically become law if the governor does not act.

2. In total, 23 states are currently working toward or already have some consumer protections against balance billing, according to Consumer Reports. That includes Tennessee, where Farm Bureau Insurance of Tennessee and state Rep. Ron Travis (R-Dayton) are working on legislation aimed at curbing balance billing.

3. New York has among the strongest consumer protectionlawsfor out-of-network billing in the nation, according to Consumer Reports. The law requires that patients in emergency medical situations pay no more to out-of-network providers than they would have paid to those that are in-network, according to the publication. Any dispute over medical bills is settled between the insurer and the medical provider.

4. At the federal level, President Barack Obama's budget proposal for 2017 includes a provision aimed at eliminating balance billing and "surprise medical bills." The provision would eliminate the balance billing of privately insured patients by requiring physicians who regularly provide services in hospitals to accept in-network rates for reimbursement, even if they aren't in the insurer's network. Separately, CMS now requires disclosure when an out-of-network physician will be providing services to protect consumers from balance billing in emergency situations, according to Consumer Reports.