What’s Being Done to Protect Consumers from “Balance Billing”?

eAlert 007695e1-6f75-494e-bbc0-f533c615f8b7

<p>If you have an employer health plan or bought coverage on our own, you probably expect that if you pay your premiums and use in-network providers, your health plan will cover the cost of medically necessary care beyond whatever cost-sharing is required. But if you were treated by an out-of-network provider in an emergency department or an in-network hospital, you might receive something unexpected: a “balance bill” for the amount your insurer wouldn’t pay.</p><p>With Commonwealth Fund support, Georgetown University researchers Kevin Lucia, Jack Hoadley, and Ashley Williams analyzed laws in all 50 states and the District of Columbia to find out what officials are doing to safeguard consumers from a confusing practice that can create significant financial burdens for consumers. </p>
<p>The authors find that most states don’t have laws that directly protect consumers from balance billing by an out-of-network provider in an ED or in-network hospital. But with narrow provider networks becoming increasingly common, lawmakers in a number of states may be poised to strengthen protections. Meanwhile, a few states, like Maryland and New York, have developed comprehensive solutions that balance the interests of consumers, providers, and insurers.</p>

http://www.commonwealthfund.org/publications/newsletters/ealerts/2017/jun/whats-being-done-to-protect-consumers-from-balance-billing Read more