Controversial Medical Billing Practices by the medical profession

Controversial billing practice may account for $1 billion in medical fees paid by patients.
BusinessWeek (8/29, Terhune) reports, "As healthcare costs continue to soar, millions of confused consumers are paying medical bills they don't actually owe" due to a common, yet often illegal practice known as balance billing. When this happens, "an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid," and the provider "demands the balance from the patient." BusinessWeek notes that "state and federal laws generally bar the medical providers from pressuring patients to pay the difference." Yet, as this practice continues, "economists and patient advocates estimate that consumers pay $1 billion or more a year for which they're not responsible." In fact, in California alone, an estimated "1.76 million policyholders...received such bills in the past two years, totaling $528 million," and 56 percent paid.

Typically, patients fall victim to balance billing when "medical providers participating in a managed-care network believe the plan's insurer is imposing too deep a discount on medical bills or is taking too long to pay." Currently, 47 states "ban in-network providers from billing insured patients beyond co-payments or co-insurance required by the plan," and "federal law prohibits providers from billing Medicare patients for unpaid balances." Yet, "regulators in most states have been slow to take action in billing disputes."