What is surprise medical billing, and what’s being done about it?

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Health Matters <--KICKER

Qing Yang and Kevin Parker

More than once, patients have asked whether I was “in-network” for their insurance plan. It’s five minutes before I’m about to put them to sleep for life-saving surgery, and the prospect of getting a hefty bill from me worries them more than their fractured limbs or burst appendices. Fortunately, I belong to the same health system that runs my hospital, so I reassure the patients that if the hospital is in-network for them, then so am I, and I swiftly wheel them into the operating room. 

“Surprise billing” is a major cause of medical debt. It happens when patients receive care from out-of-network providers, often unknowingly and involuntarily, and their insurance plans cover none or only a small portion of the cost of care. It’s also called “balance billing,” because the providers are requesting the patients to pay for the difference between the insurer’s payment and what they charge — which is usually much higher than the in-network price. Surprise billing has affected one in five Americans, amounting to $40 billion each year. Patients and families see their credit destroyed, even driven to bankruptcy, despite having health insurance.   



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