Collector - July 2020 - 21

I

What's

Inside?
Many states have laws to
curb surprise medical billing.
While most of these don't have
specific requirements for debt
collectors, it's still important
to be aware of them so you
can work with your health care
clients to ensure the laws have
been followed on the front-end.

By Andrew Pavlik

COLLECTOR 07.20

n recent years, many states have enacted
laws designed to protect consumers
from the practice of "surprise billing,"
also referred to as "balance billing."
Surprise billing typically occurs when an
insured patient receives emergency care
from an out-of-network provider or when
an insured patient receives elective nonemergency care at an in-network facility but
is inadvertently (and often unknowingly)
treated by an out-of-network health care
provider.
A 2016 Kaiser Family Foundation
survey of medical debt found that among
individuals who faced out-of-network bills
they could not afford to pay, nearly 7 in 10
did not know that the medical professional
providing the care in question was an
out-of-network provider. These out-ofnetwork providers are not bound by the
contractual in-network rate agreements with
the consumer's insurer and, therefore, the
consumer may end up having higher out-ofpocket costs for the care they provide.
Many health care providers, particularly in
the emergency and urgent-care contexts, use
outsourcing agencies for anesthesiologists,
pathologists, radiologists or other specialists.
In other cases, a patient may be injured while
traveling and need emergency care at an outof-network hospital, or a patient may end
up being transported in an ambulance that
is out-of-network. In any of these instances,
the patient's insurer does not have a contract
with the out-of-network facility or provider,
and therefore may decline to pay some or all
of the bill. This results in the out-of-network
facility or provider billing the patient for the
remaining balance of the bill.

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Collector - July 2020

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