balance billing

After being badly injured in an accident, you should be focused on your medical 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, but after a wreck, it could be just too much to deal with on your own.

Even after your own insurer has paid your claim, your health care provider may come to you demanding additional payment. This tactic is known as balance billing. Often, a doctor, hospital, outpatient clinic, or emergency room will seek money directly from a patient after getting partial reimbursement from an insurance company. 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 and not put pressure on patients. If we handle your personal injury claim, our attorneys at Joye Law Firm can act as a buffer between you and a health care provider who resorts to balance billing.

If you or a loved one has been injured in a car crash or another accident, we can handle your insurance claim and protect you from healthcare providers’ aggressive billing practices. Tell them to speak to your attorneys at Joye Law Firm! Contact our South Carolina personal injury attorneys today for a free consultation by calling (888) 324-3100 or using this online contact form.

What Is Balance Billing?

Balance billing occurs when a patient is billed for the difference between a health care 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 for medical services 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, or 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 health care providers include clauses that prohibit balance billing.

No Surprises Act Stops Some Balance Billing

balance billing

The federal No Surprises Act protects individuals covered

under group and individual health plans from getting unexpected medical bills after receiving emergency medical care and certain related services.

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

If you get health coverage through your employer, a Health Insurance Marketplace (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 authorization.
  • 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 health care 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 health care providers and facilities to give patients an easy-to-understand notice explaining the applicable billing protections and 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 that a provider or facility has violated the provisions of the No Surprise Act.

8 Steps for Fighting Balance Billing and Surprise Medical Bills

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

  1. Read the bill to see that 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 you are being billed for and the cost of each, 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 get you to pay up. But unpaid medical bills don’t appear on your credit score for 180 days after they are due. This gives you at least six months to negotiate with your health care provider or insurer.
  5. Ask your provider if they will accept a reduced amount that you can afford as payment in full. Alternately, 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 it 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 you with 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. But most injury claims are resolved through negotiated insurance 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 or step in on your behalf if you receive a surprise bill or a balance billing statement related to medical care after a personal injury accident. We can 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

For more than 50 years, Joye Law Firm has been helping injured people across South Carolina seek just compensation. 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. Call (888) 324-3100 or use this online contact form for a no-hassle, no-obligation consultation with our South Carolina personal injury attorneys.