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Beware of This Common (and Illegal) Medical Billing Practice

Billing misunderstandings are common, due to the confusing nature of medical bills in general. But if you receive a bill that seems unexpected, it’s always a good idea to investigate it before paying it. In some cases you might have been billed erroneously.

One problem that we see occasionally is a situation called “balance billing”. This practice goes against your group insurance provider’s rules, and is actually illegal. 

For example, let’s say a medical practice normally charges 300 dollars for a particular service. As an in-network provider with your insurance company, they have agreed to accept a pre-negotiated amount for that service, which is always less than the “cash” price.  In this example, let’s assume that the pre-negotiated amount is $200.

If this practice then sends you a bill for the remaining 100 dollars, this is called “balance billing” and it not only violates their agreement with the insurance provider, but it is also illegal. Unfortunately, that fact hasn’t completely stopped some providers from engaging in this practice. 

Any time you receive an unexpected bill, you have the right to question it before paying it. In some cases the bill is simply a mistake. The first thing to do is call the physician and inquire about the charges.  Most often, the billing error is not intentional and the provider will fix the issue. However, if you believe your medical provider is engaging in balance billing and they refuse to adjust the charges, the next step would be to notify your health insurance company. 

Of course, you also have the right to inquire about fees and insurance payments before scheduling an appointment with any doctor or healthcare provider. If you know what to expect, it can be easier to compare services and choose a provider that is right for you. 

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