Can A Hospital Send You A Bill 5 Months After Service And Require You To Pay If Insurance Won't

Y'all might not be obligated to pay that heaven-high medical pecker.

That's considering of a 5-year-old Mississippi police almost no 1 seems to know about.

Some large medical bills arise when a patient's insurance visitor doesn't pay the unabridged billed charges, so the health care provider bills the patient for the remainder.

This is typical when a patient receives services from a provider they weren't aware was out-of-network.

Take an anesthesiologist's bill, for example.

Anesthesiologists often pecker separately from other providers, such as hospitals, and are sometimes not included in an insurer's network, leading to a surprise beak.

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If the anesthesiologist accepts a patient'due south $100 insurance payment on a $1,000 nib, the anesthesiologist might bill the patient the remaining $900.

This is also called a "residuum bill" and it'due south prohibited by Mississippi state police.

Still, information technology happens.

"Medical providers, a lot of them, truly are not enlightened of this law," said Michelle Fuller, an employee benefit adviser in Hattiesburg. "When we make them aware of it and the administrators find that it is a legitimate law, they write off the residuum bill."

Mississippi Insurance Commissioner Mike Chaney

'Tap dancing on razor blades'

Fuller said she sees instances of balance billing — either with her clients or her peers' clients — at least once a month, despite information technology being prohibited by land law.

"Something gets lost in communication, in messaging," Fuller said, acknowledging that while Mississippi's anti-balance billing law gives some protections to consumers, it'southward not consistently enforced.

A patient who receives a balance bill can contact the Mississippi Insurance Section or the Mississippi attorney general, which both say they can help mediate counterbalanced bills but also say they cannot enforce the law.

Because Insurance Commissioner Mike Chaney's part doesn't have jurisdiction to regulate health care providers, he said he's limited to simply telling providers they can't practice that.

"I'm tap dancing on razor blades," Chaney said.

Chaney said he's had success with providers dropping balance bills, except in the case of air ambulances, which contend they are not subject to country regulations.

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Mississippi passed its anti-balance billing police in 2013. Information technology coincided with a fall-out between Health Management Assembly-owned hospitals and Blue Cross Blue Shield after the insurance company pulled out of contracts with several Mississippi hospitals.

House Insurance Chairman Gary Chism, R-Columbus, an insurance agent and the bill's writer, said lawmakers were trying to make certain patients weren't harmed by the industry spat, which could have left patients out-of-network and receiving big bills.

"You expect if you're in-network that insurance pays the nib," Chism said. "But out-of-network is where the defoliation is."

Co-ordinate to the law, if a provider accepts whatsoever insurance payment — even a lower, out-of-network payment — it should consider the bill paid in full and may non accuse the balance to the patient.

One caveat is that the law only applies when the provider accepts the insurance assignment at the outset. Otherwise, the provider can refuse to take the insurance and bill the patient the entire amount. The patient would then have to file the merits with the insurance company.

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Nether the radar

Dr. Randy Easterling of Vicksburg serves on the State Board of Medical Licensure.

During the 2013 session, Medicaid expansion dominated health care conversations, so the anti-balance billing constabulary passed without much fanfare.

Dr. Randy Easterling, who was president of the Mississippi State Medical Association in 2009 and sits on the Mississippi State Board of Medical Licensure, said he didn't know about the law and was skeptical when the Clarion Ledger brought information technology to his attending.

"This would exist a beak that would have been very hotly contested, on the radar of the medical association when it passed and I don't recall a matter about it," he said. "If it is in fact law, it's a patient protection law and patients accept the right to know."

Effectually the time the anti-balance billing law passed, lawmakers were mulling another proposed bill referred to as the "whatsoever willing provider" law. It would accept required insurance companies to contract with whatsoever provider who wished to be in their network.

This law, which would have benefited providers, never passed, and instead, the law favoring insurance companies passed relatively undetected.

"This seems inherently unfair to providers that they can't exercise reasonable balance billing," Easterling said.

Farther study needed

Mississippi is ane of 21 states — and 1 of the only states in the Southeast — that accept laws restricting rest billing.

At a regional insurance height post-obit the enactment of the police, Fuller said, insurance professionals from other states that do not accept an anti-balance billing law looked at Mississippi as an example.

"We were the envy of all these other states," Fuller said. "They were trying to become their legislatures to laissez passer something like this. You have to have a lot of courage to pass something like this."

In many states, the laws against residual billing say patients practise non have to pay balance bills, but they do non really prohibit providers from residue billing. If a patient doesn't know about the police force, they're likely to pay the nib they had no obligation to pay.

Mississippi'south law does prohibit providers from rest billing, but in practice, they've not been penalized for doing so.

Mississippi Code 83-9-5 states: "If the insured provides the insurer with written direction that all or a portion of whatsoever indemnities or benefits provided past the policy exist paid to a licensed health intendance provider rendering infirmary, nursing, medical or surgical services, and then the insurer shall pay directly the licensed health intendance provider rendering such services. That payment shall be considered payment in full to the provider, who may not pecker or collect from the insured whatsoever corporeality above that payment, other than the deductible, coinsurance, copayment or other charges for equipment or services requested by the insured that are noncovered benefits."

The law does non define a patient's recourse if they receive a balance bill.

The attorney full general'due south role told the Clarion Ledger it accepts rest billing complaints, which are handled through voluntary arbitration. But if the provider refuses to mediate, the attorney general'due south office refers the consumer to Justice Court or a individual attorney.

Chism told Blaring Ledger he understand's the insurance commissioner's limitations. He questioned whether the state should give Chaney the authority to enforce the law on providers or hogtie the attorney general to have activity.

Chism promised to written report the upshot further and file a pecker to clarify the law during the 2019 legislative session.

"It looks similar we demand to address that once again in the statute so that someone would not have to get to no great expense for a provider to obey the law," Chism said.

'Political hot potato'

The attorney general'due south office has waged legal battles confronting companies for deploying illegal business practices. The attorney general has wide authority to sue on behalf of the citizens of Mississippi "when such proceedings would be in the public interest, when a company commits an act which constitutes an 'unfair or deceptive trade practice,'" according to an AG statement.

The attorney general has not taken up the balance billing issue and his spokeswoman said it is a affair for private litigation.

While Chaney said the attorney general has shown some cooperation to address health insurance issues in the state, "the AG is not going to dig into balance billing, politically, in this day in historic period," he said.

"It's a hot murphy politically," Chaney said. "At that place are some major hospitals that are trying to circumvent the law through contracts and proverb that contract providers are not function of the network so they can residue pecker."

The Clarion Ledger asked the attorney full general's function for all complaints it has received regarding residuum billing by hospitals and ambulances. A spokesperson said the office found five complaints regarding medical billing — not specifically residue billing — and asked the newspaper to pay most $200 for the records.

One concern — a sort of catch 22 — is that if patients and their advocates starting time compelling providers to refrain from residue billing, out-of-network providers could choose to pass up to have insurance assignments birthday. Then they could neb the patient the total amount.

Chism isn't concerned about this scenario: "I call back they (providers) would desire to have 60 to 70 percent of the bill paid and accept their chances on a balance bill," he said.

Subsequently existence forced to write off residuum bills, Fuller said, some providers have joined insurance networks because they become a college reimbursement from the contracted rates versus the out-of-network rates.

Another hitch is that once a provider joins all insurance networks, they lose leverage in negotiating reimbursement rates.

What you should do if y'all remember you've received a remainder bill

Brand sure it's really a residue bill: Know your deductible, co-payment or co-insurance. Your program may require you to pay 20 percent of the billed charges. There are some services your programme may not encompass. If you're having trouble understanding the provider's bill or your insurer's explanation of benefits, phone call the provider or insurer and ask them to explain.

Call your insurance visitor to make sure it'south non a mistake. Under the Mississippi Insurance Department's "network capability" regulation, insurers must make emergency services accessible to patients 24/7, then depending on the circumstances of the charges, the insurer may have an obligation to pay more than than its "allowed corporeality" for out-of-network providers.

Call the Mississippi Insurance Section at i-800-562-2957 and ask for help mediating a residue bill.

Call the attorney general's role's Consumer Protection Division at 601-359-4230 or file a complaint at http://world wide web.ago.land.ms.usa/forms/consumer-protection-complaint-form/.

Call the Mississippi Health Advocacy Programme at 601-353-0845.

Call your state lawmaker and ask him or her to support consumer protections related to medical billing.

Contact the Clarion Ledger at awolfe@gannett.com to tell your story.