It’s the stuff of parents’ nightmares: A child takes a bad fall on the playground and comes away limping, and bleeding from a cut on his forehead. A broken bone? Concussion?
Panic often follows such incidents, and the inclination of many parents is to rush the child to the nearest emergency room. While that move likely will get the child the care he or she needs—the obvious priority at the time—certain other factors that are not top of mind at that moment can affect the ultimate financial cost of the parents’ decision.
As Business Report details in a feature from the current issue, patients across the country are becoming increasingly aware of the possibility that health care services they receive in various settings may carry unforeseen charges. The charges often result from “balance billing,” a practice in which doctors and other health care providers may bill patients for charges not fully covered by their insurance policies.
Typically, balance billing occurs when a patient receives services from a provider who either is not associated with or is outside the network of that patient’s insurance carrier. Because the insurance reimburses an out-of-network provider at a discount relative to the provider’s normal rates, the provider legally is allowed to bill the patient for the difference. Depending on the type and level of service rendered, a patient can incur hundreds or even thousands of dollars in unanticipated charges.
Some types of care that commonly trigger these patient invoices involve anesthesiology, radiology, laboratory and emergency room services. Doctors in these areas often do not work directly for a hospital but are independent contractors or members of a practice group that contracts with the hospital. As such, it is up to them to sign—or not sign—their own deals with insurance companies.
In some states, the inconsistencies in insurance coverage related to provider networks have become big issues. While balance billing is not an unknown practice in Louisiana, some say it is not as pervasive as in some other states. Read the full feature. Send your comments to editors@businessreport.com.
