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When Providers “Balance Bill”: What Are States Doing to Protect Consumers?

balance billing by health care providers

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. 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. 

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