New Balance Billing Law in Colorado

[RetMD21]

Quote:

Originally Posted by pb4uski ^^^^ Might be true in your state but not universal. From a Congressional Research Service document on balance billing:

Good point! they can bill for the less than 15% they are allowed above the Medicare payment amout. What I meant to say is that they can't bill for the difference between their exorbitant "list price" and the Medicare amount.

Also if they are nonparticipating the patient is paid by Medicare. Not many physicians doing the nonparticipating track.

[MichaelB]

Quote:

Originally Posted by pb4uski True on the initial bill because it is subject to adjudication with the insurer.... but after the in-network provider has been paid by the insurer they typically show the rack rate, a discount for the difference between their rack rate and the negotiated rate and also the amount paid by the insurer and the balance due from the patient... which will generally agree to the insurer's EOB and the patient that is paying attention then knows that it is probably ok to pay. Similarly, a rack rate bill is acceptable because it is subject to adjudication with the insurer. But after that adjudication, the out-of network provider will show the rack rate, the amount paid by the insurer and then the difference even though by law they can't collect the entire difference and they can only collect the excess of the negotiated rate over what the insurer paid. It doesn't trouble you that a provider can bill for something that statute says that they can't collect? It seems to be dancing on fraud to me: The out-of-network provider is intentionally misrepresenting that and amouis due that they don't have the legal right to collect.... to induce the patient to pay them money that they are not legally entitled to... which results in economic damages to the ignorant patient that pays the bill.

Many things trouble me about the health care system. I think the Colorado legislature took a big step in the right direction to overrule a practice that is deeply exploitative, and your previous post was too harsh on the lawmakers. To say a balance bill is now fraud is excessive, especially since the new law protects some patients and disallows the excess charges in some cases but not others. Balance billing is still allowed in some cases in Colorado.

Health care providers, especially hospitals, have so many different prices there is no list price or rack rate. The price for an uninsured or underinsured patient can be 15x or 20x the Medicare or insurance contract rate and can differ by a factor of 2x or 3x from similar local or regional hospitals, yet they routinely send out these monsterous bills and demand payment, even when they know the contracted price is 80%-90% less. The pricing, billing and collection of health care follows few rules.

I agree that sending a balance bill that no longer applies should be discouraged. If a provider makes an effort to misrepresent the bill, I would agree it is a matter for regulator action. The Colorado balance billing act, with all its warts and shortcomings, is a positive step for insurers and consumers alike, and I applaud their effort.