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and life along the winding road

Tuesday, March 4, 2014

Balance Billing

One of the annoying things about health care in the U.S. (one of many) is that just because you go to a doctors office or hospital that is within your insurance network, it doesn't mean the actual doctor who you see is also in the network (they have to individually negotiate a contract with the insurance company). Often the reason they haven't signed a contract is because the doctor doesn't want to take the lower rate the insurance company offers. Obviously if you are in the E.R. for an emergency, you don't stop to ask if the doctor on call is within the network, but what happens is the patient ends up paying an exorbitant higher amount for services.

If you're in Texas you can read about policies at the Center for Public Policy Priorities.

If your bill is $1,000 or more, you can ask the Texas Department of Insurance to mediate for you or contact the Office of the Attorney General. (They may look into bills that are less than $1,000)

You can check rates for procedures here (make sure you get an itemized bill)

NBC News showed a special report regarding new state rules.

You can watch the video here


Mason Canyon said...

I don't think that is anywhere near right. If the hospital is in your network, then all the doctors there should be covered. It's almost to the point where you have to have a lawyer with you when you get sick. Such a shame. Great information here, thanks.

L. D. said...

Having no insurance at this time makes me a little concerned about my future. I know that I should sign up but I am not going to right now. I think there are more people without insurance than ever before all this started. Iowa will probably put me on medicaid until I get to medicare.

Cozy in Texas said...

Mason, doctors agree to work in the E.R. as part of their privileges to use the hospital, but don't always have contracts with the same insurance companies. They also get paid a fee (over $1,000) to be on call. It's all about money.

L.D. I agree, my insurance has gone up so much since "Affordable" health care that I doubt I can continue much longer. The cheaper policies they are advertising are for HMOs and unless you can find a doctor who is willing to refer you to a specialist you won't get the care you need. I also have concerns that the government system is not protecting our privacy - it's a mess.

Joanne said...

It is a mess. But I think it began with insurance companies a long time ago and they are not going to give up profit. And if Affordable Health Care is repealed I can see prices going up more, not back to "before" or reasonable. It's all a political game at the expense of people's health.

Cozy in Texas said...

I agree Joanne. Trying to put the insurance companies in a box is like herding cats. Either way it won't end well for people in the middle.