Protecting patients from balance billing

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If you have medical expenses, then it’s possible that you might receive a balance bill—the difference between what health insurance reimburses and a health-care provider charges.

Balance bills can affect consumers significantly, says Jack Hoadley, who is a research professor at Georgetown University’s Health Policy Institute and co-author of a June 2015 report on balance billing. Although specific numbers are difficult to come by, Hoadley says, “We know there are some pretty dramatic examples of it happening.”

Most states provide some balance-billing protection, although as of 2013—the latest data that are available—only 13 prevent it to some degree in the case of out-of-network health-care providers.

Hoadley believes that balance billing will increase, because today’s insurance plans include fewer providers and classify more doctors and hospitals as “out of network” to keep insurance costs low. Providers who are left out of an insurer’s network might not be so willing to take the insurer’s first offer, Hoadley says.

If you’re hit by a balance bill, you shouldn’t pay it immediately, experts say. Instead, you should try to negotiate the amount with the health-care provider, experts say. You should request an itemized bill of specific charges, so you can discuss line-by-line details.

Be cordial and inquiring and not agitated, “because you want to make sure you can get your point across,” says Erin Singleton of Patient Advocate Foundation. “Everything is negotiable.”

Kaiser Family Foundation lists how states protect consumers from balance billing at kff.org.