Surprise billing surprises everyone, except the insurance companies

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. In the past several years, there has been a dramatic increase in media attention concerning bills patients receive from health care professionals who are not in the network of providers their insurance company contracted with to provide health services. The out-of-network bills these patients receive have been termed “surprise bills” by the insurance industry, but are also often termed “balance” or “out-of-network” billing. Balance billing occurs when a patient receives a bill for the amount remaining between the out-of-network provider’s charge and the payment made by the insurer after copay and deductibles. However, a more accurate label for this undesirable circumstance is “surprise insurance gaps.” The focus of concern with out-of-network billing has often been with facility-based providers that patients assumed would be covered like their in-network surgeon and hospital. Facility-based providers include radiologists, pathologists, physician anesthesiologists, and emergency room physicians. Patients of scheduled and unscheduled procedures can find it difficult to ensure these physicians are within their insurer’s network. Instead of researching why insurance companies are contracting with fewer and fewer providers, lawmakers are being called on to fix this issue. Examples of legislation they are asked to promote include bans on out-of-network payments, r...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Physician Medicare Source Type: blogs