After you have been injured in an accident, your main focus should be on getting better. Too often, though, this gets pushed aside by other issues. You find yourself dealing with insurance companies, deductibles, adjusters and medical administrators.
Sometimes you don’t get treated fairly and you may never know it. This happens through tactics such as balance billing.
Balance billing occurs when a health care provider – such as a doctor, hospital, outpatient clinic or emergency room – tries to collect money directly from a patient after getting partial reimbursement from an insurance company. In many cases, balance billing is illegal.
South Carolina Personal Injury Attorneys
If you or a loved one has been in a car crash or other accident, make sure your financial rights are protected. Call Joye Law Firm. Contact our South Carolina personal injury attorneys today by calling 877-936-9707 or using this online contact form.
Joye Law Firm has been helping injured people and their families in Charleston, Clinton, Columbia, Myrtle Beach and throughout South Carolina since 1968. Let us help you today.
Protect Yourself Against Balance Billing
Health insurance policies are complicated documents. They can be hard to read and understand. It is even harder for someone who is hurting and in physical pain.
Some people have personal health insurance policies. Others are covered by group plans provided by their employers. Many people have no insurance at all or are covered only by Medicare or Medicaid. Regardless of your type of coverage, you want to make sure your medical bills are paid.
In a typical scenario, you go to a doctor for treatment. The doctor then submits a request for insurance reimbursement. Sometimes the insurance company pays 100 percent of the doctor’s charge for the service provided. Often the insurer pays only a portion of the charge.
Balance billing is when the doctor tries to get you to pay the difference – or balance – between the alleged “cost” of the medical service and the amount the insurance company paid.
Balance Billing Takes Money Out of Injured People’s Pockets
Balance billing is often used by health care providers that participate in a managed-care network but think the plan doesn’t pay them enough or takes too long to pay. Quite simply, it is a way for doctors to make more money. A report by America’s Health Insurance Plans found that some providers are charging exorbitant rates – sometimes up to 70 times the Medicare reimbursement for similar services.
At Joye Law Firm, we believe if doctors have a problem with their payments, they should talk with the insurance company and not put pressure on patients.
Some experts estimate that consumers pay one billion dollars or more a year in improper balance billing. One study revealed that 1.76 million people in California who visited an emergency room over a two-year period were balance-billed an average of $300 each. Some of the charges were legitimate, and some were not. About half the patients – more than 800,000 of them – paid the bills anyway.
Balance billing is not always illegal. But it almost always complicates what is already a complicated situation. And it causes confusion and stress for patients.
6 Things You Should Know About Balance Billing
- Balance billing is illegal for all approved Medicare services.
- Almost all states have laws that require medical providers who have contracted with a health plan to seek payment only from that health plan and not from their patients.
- These laws vary from state to state and may include only some types of health plans.
- Co-payments, coinsurance and deductibles are the patient’s responsibility.
- Review your health insurance policy to see if there is a clause preventing balance billing.
- Contact a South Carolina accident and injury lawyer immediately if you have any questions.
Free Consultation With a South Carolina Injury and Insurance Lawyer
Joye Law Firm has nearly 250 years of combined experience dealing with insurance companies. Find out how we can help you. Call Joye Law Firm. Call 877-936-9707 or use this online contact form for a no-hassle, no-obligation consultation with our South Carolina personal injury attorneys.
We can take care of the insurance paperwork so that you can concentrate on getting well.
- Department of Health and Human Services – Center for Medicare & Medicaid Services