Do you know whether you are the victim of balance billing?

Your medical bills are already high as a victim in an accident, but is balance billing making them even higher?

If you’ve recently been hurt in an accident, you might have filed your own insurance claim or legal claim against the responsible party, but that may not stop medical bills from showing up in your mail. Sometimes these medical bills are unexpected and very expensive even after the insurance company claims it has paid their portion for treatment.

If the balance listed on the bill is much higher than you expected and insurance has already been processed, this could be an instance of something known as balance billing.

If you’ve been the victim of an accident, balance billing could also affect your personal injury claim. It’s important to have professionals working with you to help you navigate these difficult situations to get the care you need without having to unnecessarily deal with unfair billing practices.

What is Balance Billing?

When the patient receives a bill for the difference between what was charged by the provider and what was paid by the patient’s insurer, this is known as balance billing. Balance billing does not include payments assigned to the patient for coinsurance, deductibles, or co-pays. You should review your insurance explanation of benefits carefully and compare it against your insurance policy to verify that the right amount was charged to you.

In many cases, balance billing is not legal. Under in-network agreements, balance billing should not happen because that healthcare facility or provider has already agreed to take the negotiated fees with the insurance company.

However, when a provider is considered out of network, then the legal practice of balance billing can put a patient in the position of receiving multiple medical expense bills they didn’t expect. The healthcare provider is not limited as to the amount the patient can be billed when the patient is considered ‘out of network’.

Some patients have claimed that they’ve been subjected to massive surprise bills under the practice of balance billing. This situation is particularly troubling for victims of serious slip and fall or vehicle accidents who have many medical appointments and treatments. It can be difficult for a victim to sort out what’s considered in vs out of network. As the bills pile up, this adds more stress for someone already attempting to recover from devastating injuries.

Multiple Injuries Can Lead to Multiple Bills

Most victims who have been hurt in a serious car crash will go to the hospital immediately for screening and treatment. Given that car accidents can cause critical injuries and usually more than one injury, the cost for treatment in the emergency room alone can be extensive and expensive.

If a patient is seen by a doctor, treated for lacerations, screened using diagnostic technology to rule out more serious bone or internal injuries, and then given medication, it’s not uncommon for the total cost of this one visit to stretch into thousands of dollars.

If surgery is required for the patient or other treatments are used either in the short term or in follow-up procedures, a victim who was hurt due to another person’s reckless behavior can find themselves on the receiving end of stressful medical bills.

What Are the Relevant Laws Related to Balance Billing?

California recently pushed a proposed law to the next session that would control price gouging from insurers in the form of balance billing. Other states are also evaluating measures that could curb this practice and make insurance companies accountable.

Victims face unique challenges in trying to recover from their injuries. One such example is getting their medical expenses paid for appropriately. When victims have little or no say in choosing the facility in which they’re treated, this adds a further layer of difficulty. Personal injury lawyers can play an important role in helping a victim address these challenges and to fight for fair compensation for medical bills and other expenses.

Some of the most alarming surprise bills affecting California residents have been associated with ambulance and emergency care. Most people calling the hospital for emergency services don’t stop to ask whether or not the doctor or facility is in network.

California and a few other states have already taken some action to protect consumers from surprise medical bills. In California, the Knox-Keene Act now requires that any plans regulated under the Department of Managed Care have to pay providers for any emergency care services even if the providers were not specifically contracted.

In 2016 California passed another law, A.B. 72, with the goal of decreasing the number of surprise medical bills. Under this law, if a patient went to a facility considered in network by their insurance provider but is then seen by a provider not in the network, provisional payments of an average contracted rate must be made by the health plan to the provider.

However, California’s balance billing protections don’t extend to all health plans in the state, leaving more than one million residents in the state unprotected. For plans regulated by the federal government, their plan subscribers may not be protected by the emergency care laws, either.

Even with these laws on the books, numerous patients have received costly medical bills that can go into the tens of thousands of dollars. Some experts argue that even state laws won’t go far enough to protect consumers from receiving huge bills after care has been provided, arguing instead that federal action is necessary instead.

What You Can Do

The balance billing on medical bills might become a part of the car insurance claim or in further personal injury litigation filed against the responsible party. For a victim, keeping track of all this information is overwhelming and confusing. Having the support of a dedicated personal injury lawyer, like the attorneys at Dunnion Law, empowers the victim to remain focused on their medical treatment. Our attorneys keep track of all your medical bills and analyze them for discrepancies or problems.

This information is then organized and presented as part of your personal injury claim. If you have other questions about balance billing, negotiating settlements with insurance companies, or other obstacles you’re facing as the victim of a personal injury accident, talk to the experienced California injury attorneys at Dunnion Law today.