Surprise medical billing is one of the hot topics that has been trending in the healthcare industry recently. Despite doing tons of research, picking the right plan, and paying the premium on time, patients sometimes receive surprise bills for the care they get from their in-network facility. They get such huge bills because an out-of-network Provider might have rendered the healthcare services. Some recent real-time cases have hit the headlines and the issue blew up, reaching the forefront of the US healthcare discussion. Let’s discuss more this issue:
Surprise Medical Billing in Detail: Most patients think they have invested in the best healthcare insurance and their coverage will save them during unlikely healthcare emergencies. However, the reality is one in every five patients get emergency care from an out-of-network provider, resulting in huge medical bills. The same has been proved by the latest analysis made by the Kaiser Family Foundation. As per the research findings, at least 1 out-of-network bill is received by a patient for every 18% of emergency visits and 16% of in-network hospital stays.
Real-time Cases: Numerous cases of surprise medical billing or balance billing have been recorded in recent times and it is the reason why the issue hit the headlines. Some of them are,
- A radiologist lost an arm during an accident and was charged with $56,000 for the air ambulance ride
- A teacher from Texas who had a heart attack was billed with $100,000
Balance Billing Protection Act: To provide a solution, Commissioner Kreidler requested legislation to pass a bill called the Balance Billing Protection Act. It was passed successfully on April 2019. As per the act, patients will not get surprise bills even though they are given emergency services by an out-of-network provider. The insurance company and the Provider should agree on a price for the covered services. If not, they go to arbitration instead of sending huge medical bills to patients. Some key features of this act include,
- The act will take effect on Jan 1, 2020
- Update the websites with Provider networks
- Insurance companies and Providers should provide patients with a detailed notice that quote their rights and when they will be balance billed
- The out-of-network Provider and the insurance company should agree upon a market rate that is reasonable. In case there is a dispute, they resolve it by demanding arbitration
- If a Provider continues to balance bill his patients, then disciplinary action will be taken on him by the Department of Health.
Outsourcing: As Providers and healthcare facilities struggle to tackle this issue, US medical billing companies can only do so much to keep their clients’ medical billing operations up and running. For better functioning and revenue generation, medical billing companies can get help from offshore companies. India is the top destination to find some of the highly-experienced offshore vendors.
About e-care India:
Medical billing in India is booming and if you are on the lookout for a renowned company, then checkout e-care India. With twin ISO certifications – ISO 9001:2015 for our operational processes and ISO 27001:2013 for ISMS (Information Security and Management systems), this company ensures the highest PHI security. It has 3 offshore medical billing delivery centers to provide medical billing and coding services to its clients. Acting as a virtual back office from India, e-care will continue to provide its endless support 24/7. To know more about e-care and its services, log on to www.ecareindia.com.