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Those ‘balance billing’ blues

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This Los Angeles Times story tells how patients get very unpleasant surprises when out-of-network costs lurk in in-network hospitals.

Consider those surprise bills from physicians who don’t participate in patients’ health plans but who do practice in hospitals that do. With no contract in place to dictate how much they get paid for services, they can bill patients for charges beyond what insurance covers.

The doctors ┬ácharge for the balance of the bill not covered by insurance. It’s ┬ácalled “balance billing.”

“It’s an abuse of the implicit trust that you have with your doctor and with your healthcare providers,” Gerald Kominski, director of UCLA’s Center for Health Policy Research, complained to the Los Angeles Times.

The paper noted that {f}ederal law doesn’t protect patients from these surprise bills. The Affordable Care Act requires insurers to cover out-of-network emergency services at in-network rates, but it doesn’t stop doctors from balance billing.

And figuring out which doctors participate with which health plans can be easier said than done.



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