Balance Billing Sparks Disputes Between Physicians/insurers

[yorkriver1]

http://www.modernhealthcare.com/art...tals-in-middle-as-insurers-and-doctors-battle

In/out of network issues for contracted docs that insured's didn't pick, like for emergency room/surgery.

This may be ok for insureds under 65 on HMO's--like the article says, hospitals and other providers have to fight over who's on the hook. Not so great for any on PPO's, and, for balance billing on Medicare for docs who don't accept "Medicare Assignment"--agents in the Medicare space have the specs on that one.

 

[Yagents]

Love this comment from behind the curtain:

A growing number of hospitals and insurers are setting up processes to resolve out-of-network bills before the problem escalates into a public relations disaster that could undermine support for narrow-network plans.

 

[AllenChicago]

Undermine support from whom? The public? Physicians? Insurers? Narrow networks were forced on everyone by ObamaScare. Hardly heard this terminology before 2014.

 

[somarco]

Non-par providers in Medicare can only "balance bill" for excess charges by formula.

Non-participating physicians: These doctors don't routinely take assignment but they do submit claims to Medicare. Medicare will process that claim and send its portion of payment (80%) to the beneficiary, who must pay the physician directly (either up front or after receiving Medicare payment). A Medigap policy will cover the 20%.
In these cases, the physician may tack on an additional amount, up to 15% more than the Medicare-approved amount. The beneficiary is responsible for this. If the Medigap policy has an excess charges benefit, the policy will cover the additional amount.

If you have an MA plan and see a non-par provider they are limited to either the Medicare allowance or the excess charge calculation if they do not accept assignment.

Narrow networks were forced on everyone by ObamaScare. Hardly heard this terminology before 2014.

Are you referring to balance billing or narrow networks?

 

[1raggedhole]

Hmmmmm. Welcome to 1990. Not you op. This kid that wrote the article has no past experience that I can see. This has been a problem since the advent of managed care. That is the problem with this law. Nobody that had a hand in writing it knew what the hell they were doing. I am glad I had an out to leave this crazy business after 23 years. I don't know how you guys can stomach it.

 

[somarco]

I am glad I had an out to leave this crazy business after 23 years.

Then why are you here?