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    After being badly injured in an accident, you should be able to rest and focus on your recovery. Unfortunately, you’ll likely find much of your time taken up by dealing with insurance companies and medical administrators. Dealing with insurance and medical payments is difficult regardless of your health status. After a serious auto wreck, however, it could be just too much to deal with on your own.

    Even after your own insurer has paid your claim, your healthcare provider may come to you demanding additional payment. This tactic is known as balance billing. In some cases, balance billing is illegal.

    At Joye Law Firm, we believe that if doctors have a problem with their payments, they should talk with the insurance company instead of pressuring their patients.

    If you or a loved one has been injured in a car crash or another accident, let our attorneys act as a buffer between you and a healthcare provider who resorts to balance billing. Our attorneys can handle your insurance claim while protecting you from aggressive billing practices. If a healthcare provider calls seeking payment, tell them to speak to your attorneys at Joye Law Firm! Contact our South Carolina personal injury attorneys today for a free consultation.

    What Is Balance Billing?

    Balance billing occurs when a patient is billed for the difference between a healthcare provider’s original charge and the amount the patient’s insurance has paid the provider. It often happens when a person with health insurance receives medical care from a provider or a facility outside of their health plan’s network.

    Balance billing is also referred to as surprise billing because the bill is unexpected.

    In a typical scenario, you are taken to the hospital for treatment after a serious accident. The hospital or individual providers then submit their requests for insurance reimbursement. Sometimes the insurance company pays 100% of the charges sought for medical services. But typically, the insurer pays a set amount of what a doctor or hospital charges.

    Some providers will try to get you to pay the difference between what they charge and the amount the insurance company pays. For example, if the provider billed $1,000 and the insurer paid $750, the provider may bill you for the remaining $250.

    Unless there is an agreement not to bill the balance, medical providers may bill patients for any amount not paid by most insurance.

    People with Medicare, Medicaid, TRICARE, or who receive care through the Veterans Administration or Indian Health Services are not at risk for balance billing. Agreements between these programs and healthcare providers include clauses that prohibit balance billing.

    Understanding Your Health Insurance Policy

    Navigating the complexities of your health insurance policy can seem daunting. However, understanding key components is essential to avoiding unexpected medical bills. In this section, we will guide you through some policy basics:

    In-Network vs. Out-of-Network Providershealth insurance

    Provider networks consist of doctors, pharmacies, and facilities that contract with insurance companies. In-network providers have agreed to provide services to members at a negotiated rate. Visiting in-network providers generally means lower out-of-pocket costs for you, as your insurance covers a larger portion of the costs.

    Out-of-network providers have not agreed to the negotiated rates with your insurance company. Seeking services from out-of-network providers can result in higher out-of-pocket expenses. Insurance plans typically cover a smaller percentage of costs for out-of-network providers, if any.


    Your deductible is the amount you must pay out-of-pocket for healthcare services before your health insurance begins to pay. For example, if your deductible is $1,000, your health insurance plan won’t pay anything toward some services until after you’ve already paid $1,000 out-of-pocket. Understanding your deductible is crucial for planning your healthcare expenses and what you may be responsible for.


    Copays are fixed amounts you pay for a covered healthcare service. The amount can vary by the type of service. For instance, visiting a primary care physician may have a $20 copay, while emergency room visits could have a $100 copay. Copays generally do not count towards your deductible, but do count towards your maximum out-of-pocket costs.

    Balance Billing

    Balance billing occurs when a healthcare provider bills you for the difference between their charge and the allowed amount by your health plan. This is especially common with out-of-network providers. For instance, if the provider charges $1,500 for a service but your insurance only covers up to $1,000, you might be billed for the remaining $500.

    Preventive Measures to Avoid Balance Billing

    Understanding whether your insurance policy protects you in certain situations is crucial to avoid unexpected charges. Here are some tips to help you make the most of your health insurance and avoid the pitfalls of balance billing:

    Pre-Appointment Checks
    Before scheduling an appointment, directly contact the provider or facility to confirm they are still within your insurance network. Insurance networks can change. Even if you have seen the provider before, it’s important to verify network status.
    Double-Check for Specialists and Ancillary Services:
    If your treatment involves specialists or additional services like lab work or radiology, confirm that these are also in-network, or will not be allowed to balance bill per the No Surprises Act.
    Review Emergency Care Policies:
    Make sure you understand your health insurance plan’s definition of an “emergency” and what = steps must be followed to ensure coverage. This might include notifying your insurer within a certain time frame after receiving emergency care.
    Seek Pre-Authorization:
    For planned procedures, check if your insurance requires pre-authorization. Getting pre-authorization ensures that your policy covers the service, reducing the risk of balance billing.
    Inform Your Healthcare Providers About Your Insurance Concerns:
    Let your healthcare providers know that staying within the insurance network is a priority for you. They can often offer guidance or adjust referrals to accommodate your insurance limitations.

    No Surprises Act Stops Some Balance Billing

    The federal No Surprises Act protects individuals with health insurance from getting unexpected medical bills after receiving emergency medical care and certain related services. South Carolina car accident attorneys discuss what to do about medical bills from your car accident.

    The No Surprises Act went into effect on January 1, 2022.

    If you get health coverage through your employer, a Health Insurance Marketplace (often referred to as “Obamacare”), or an individual health insurance plan you purchase directly from an insurance company, the new rules prohibit:

    • Surprise bills for most emergency services, even if you get them out-of-network and without prior approval.
    • Higher out-of-network copayments for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
    • Out-of-network charges and balance bills for certain ancillary services furnished by out-of-network providers as part of your visit to an in-network facility. Ancillary services are medical services or supplies that are not provided by acute care hospitals, doctors, or healthcare professionals.

    If you go to an in-network hospital or ambulatory surgical center for non-emergency care, balance billing isn’t allowed for any of these ancillary services:

    • Anesthesiology, pathology, radiology, or neonatology
    • Care from assistant surgeons, hospitalists, or intensivists
    • Diagnostics like radiology or laboratory services
    • Any other item or service from an out-of-network provider, if an in-network provider wasn’t available

    The new rules require healthcare providers and facilities to give patients an easy-to-understand notice explaining the applicable billing protections. They also require patient consent to waive billing protections. In other words, you must receive notice of and consent to being billed by an out-of-network provider. The notice must also say who to contact about concerns related to violations of the No Surprises Act.

    8 Steps for Fighting Balance Billing and Surprise Medical Bills

    Here are eight steps to take if you receive a bill for medical care you think was paid by your insurer. Keep notes of everything you are told by the provider and insurers.

    1. Read the bill to check if you received the services it lists. Ensure your name, contact information, date of birth, and insurance information are correct. Verify the date or dates of service. By some estimates, upwards of 80% of medical bills contain errors.
    2. Promptly confirm with the provider that they meant to send the bill. Go over it with the provider. Point out any errors and request a new bill if there is anything amiss with the original one.
    3. If the bill you received does not contain an itemized list of individual services, ask for an itemized bill. Make sure you have not been double charged for tests or procedures, or charged for items that should be included under the facility fee, such as gloves or blankets.
    4. Don’t rush to pay. Some people think they have to pay a medical bill quickly or it will go against their credit rating. Some providers may suggest this to scare you into paying up faster. However, unpaid medical bills don’t appear on your credit score until 180 days after they are due. This gives you at least six months to negotiate with your healthcare provider or insurer.
    5. Ask your provider if they will accept a reduced amount that you can afford as payment in full. Alternatively, ask if you can pay the bill in monthly installments. Be respectful and polite and explain that paying the full amount of the bill will be a financial hardship. Many healthcare providers will work with you knowing this is a better alternative than a lengthy collection process if you cannot pay. The worst they can do is say no.
    6. Ask your insurance company for help. If your insurer declined to cover a service that you believe is covered by your policy, ask for a reconsideration. If the insurer covered a payment as out-of-network care, ask them to cover it as in-network care. It will help if you have wording from your policy to support your request or a compelling reason for choosing an out-of-network provider.
    7. File an appeal with your insurer. If your insurer denies a claim, you have the option of filing a formal appeal. Your insurance company’s appeals process should be explained in your benefits handbook. If you have health insurance through your employer, the company’s human resources department should provide this information.
    8. Contact a personal injury attorney. Many people don’t realize it, but personal injury lawyers spend a lot of time negotiating with insurance companies. We take insurance companies to court when necessary, and our results sometimes make the news. However, most injury claims are resolved through negotiated settlements. Most insurers would rather settle than go to court.

    If you have a valid personal injury claim, our attorneys at Joye Law Firm can handle your claim from the start. We will take care of all of your insurance paperwork and handle the negotiations with providers and insurers so that you can concentrate on getting well.

    Contact Our Experienced S.C. Attorneys to Assist You


    Since 1968, Joye Law Firm has been helping injured people across South Carolina seek just compensation for injuries that weren’t their fault. We stand up for our clients when healthcare providers resort to unfair billing practices. Call Joye Law Firm today and find out how we can help you. Use this online contact form for a no-hassle, no-obligation consultation with our South Carolina personal injury attorneys.

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