Balance billing occurs when a patient receives a bill because an insurance company doesn’t cover its full share and the patient is billed the difference. This “difference” happens because sometimes patients may be cared for by an “out of network” doctor.
Doctors may be out of network because:
In an emergency, it is unsafe and illegal for a doctor to ask a patient about insurance. Physicians’ ultimate priority is providing their patients with the immediate care they need.
Sometimes a patient needs diagnostic, laboratory, or pathology services that cannot be provided by their regular doctor. Their regular doctor may send out a specimen for additional testing; these services are “ancillary services.” Because of insurance participation changes, the treating physician may not know if the ancillary service provider is in or out of the patient’s insurance network.
The Medical Society supports changes to reduce or eliminate surprise balance billing. For surprise billing to end, it is critical for lawmakers to work with patients and the groups that understand patients’ health best. Physicians’ ultimate priority is providing their patients with the care they need, at the time that they need it.
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