Law Change can Raise Patients out of Network Bills

Rule Change can Raise Patients out of Network Bills

Emergency doctors from two professional organizations said that change in federal law for health in November could increase cost for consumers when they are in need for emergency care out of their health plans.

The consumer advocates and the health analyst said that the solution of the problem purposed by the Law did not protect the consumers.

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Under the health law, consumer can not be overcharged on their insurance and payments when they visit the emergency that are not in their medical network by the plans.

However Law doesn’t prohibit hospital doctors balance billing to the consumers if insurance company do not pay the full payment. Such practice really had a harmful impact on the consumers, said by the consumer advocate.

Program Director at consumer union Chuck Bell said that their major interest is to get consumers out of the middle. Consumer advocacy group is making state efforts to make balance billing prohibited.

Emergency service providers say that they are in a complicated position because they are forced by the health law to treat everyone. It doesn’t mean everyone they treat have insurance or can pay the bills.

The new health law say that the insurance company should pay a reasonable amount so that consumer can afford to pay remaining amount. The word “reasonable” by the new rule of health law well defines as the greatest from the following three options.

  • The mean amount decided by the medical network providers for the emergency services.
  • The amount calculated by the same method mean the consumer going to pay for all out of medical network services.
  • The whole amount is paid by Medicare.

The American College of Emergency Physicians and the Emergency Department Practice Management Association say that the regulations first two options allow the insurance company to pay the amount because of their payment data is consumer property. Third option is not suitable because of medicare less reimbursement rates than private plans.

The standard is in place that the emergency providers say that the insurance company will pay them less and the rest will be payed by the consumer unless they are not living in those states where balance billing is prohibited.

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The emergency physicians want the balance billing process and should be adjusted by geographical variations. Database of this adjustment should be provided by the Non-profit group Fair Health. Insurance providers say that the charges are too high and the process through which they pay is opaque. American Health Plan Insurance group used the Fair Health group database to examine the out of network charges. During the years 2013-14, 1.6 million people visited emergency departments, the average consumer charges were $971, far higher than the average medicare payment of $176.


Source: NPR







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