New state law may make it easier for some insured to get big bills
Published: 2009-07-27 00:29:04
Author: Bob LaMendola | South Florida Sun Sentinel | July 6, 2009
Jerry Modell wasn't worried about the medical bills when he rushed his wife, Linda, to the hospital for a brain aneurysm in May. She had good insurance coverage.
Only later did the Coral Springs couple learn that the hospital is part of her insurer's network but not the neurosurgeon, anesthesiologist or others who treated her. Insurance pays only 60 percent of bills from out-of-network medical providers, so the Modells were told they will be responsible for the other 40 percent on top of normal co-payments.
"The cost will be in the thousands, and it's really going to hurt us," Jerry Modell said. "I don't see why they should be able to bill me extra. They're not in the network, but it's not like we could shop around."
The practice is called "balance-billing," where out-of-network providers can bill the patient for the difference between what the provider charges and what the insurer pays. A Florida law took effect last week that critics say could make the practice more prevalent and costly to consumers.
Most such bills are small and no problem, when a patient knows in advance a doctor is out-of-network and will cost extra. But sometimes, the bills are unexpected and huge, such as in emergencies when a patient is seen by a flurry of professionals, some out-of-network.
The complex, little-known practice has become a hot topic. Nationally, New York prosecutors and a congressional panel alleged this year that data used by insurance companies routinely misstated the fees of out-of-network providers so that insurers paid too little and patients paid billions more.
The new Florida law lets insurers send out-of-network payments directly to health care providers rather than to patients. That's more convenient for all and prevents patients from withholding money. But consumer advocates and even some insurers said the law may encourage doctors to drop out of networks, resulting in more patients being hit with the bills. Doctors and hospital officials deny it.
Patients in Medicare and Florida health maintenance organizations are protected from virtually all such bills, because provider contracts and state law require providers to accept what Medicare and plans pay.
But about half of insured people are in preferred provider organizations and are vulnerable. PPOs cost more and let patients see any provider out-of-network if they pay a higher co-pay. Nothing stops those providers from sending bills to PPO patients for more than insurers pay.
Full story
Published: 2009-07-27 00:29:04
Author: Bob LaMendola | South Florida Sun Sentinel | July 6, 2009
Jerry Modell wasn't worried about the medical bills when he rushed his wife, Linda, to the hospital for a brain aneurysm in May. She had good insurance coverage.
Only later did the Coral Springs couple learn that the hospital is part of her insurer's network but not the neurosurgeon, anesthesiologist or others who treated her. Insurance pays only 60 percent of bills from out-of-network medical providers, so the Modells were told they will be responsible for the other 40 percent on top of normal co-payments.
"The cost will be in the thousands, and it's really going to hurt us," Jerry Modell said. "I don't see why they should be able to bill me extra. They're not in the network, but it's not like we could shop around."
The practice is called "balance-billing," where out-of-network providers can bill the patient for the difference between what the provider charges and what the insurer pays. A Florida law took effect last week that critics say could make the practice more prevalent and costly to consumers.
Most such bills are small and no problem, when a patient knows in advance a doctor is out-of-network and will cost extra. But sometimes, the bills are unexpected and huge, such as in emergencies when a patient is seen by a flurry of professionals, some out-of-network.
The complex, little-known practice has become a hot topic. Nationally, New York prosecutors and a congressional panel alleged this year that data used by insurance companies routinely misstated the fees of out-of-network providers so that insurers paid too little and patients paid billions more.
The new Florida law lets insurers send out-of-network payments directly to health care providers rather than to patients. That's more convenient for all and prevents patients from withholding money. But consumer advocates and even some insurers said the law may encourage doctors to drop out of networks, resulting in more patients being hit with the bills. Doctors and hospital officials deny it.
Patients in Medicare and Florida health maintenance organizations are protected from virtually all such bills, because provider contracts and state law require providers to accept what Medicare and plans pay.
But about half of insured people are in preferred provider organizations and are vulnerable. PPOs cost more and let patients see any provider out-of-network if they pay a higher co-pay. Nothing stops those providers from sending bills to PPO patients for more than insurers pay.
Full story