Shocked by a Huge Medical Bill? Putting a Stop to Balance Billing

Despite the best efforts of doctors, patients and politicians, the cost of health care is going nowhere but up. While some studies show there has been stabilization in the health insurance industry, many challenges remain, and too many people still find even basic health care unaffordable.

One of the most heartbreaking issues in the health care industry is balance billing, a troubling practice that can leave patients shell-shocked and family finances shattered. So just what is balance billing, how does it work and what can be done about it? Here is a basic primer on this common health care practice.

What is Balance Billing?
Balance billing is a uniquely insidious problem, one that hits patients who think they are insured. Health insurance providers negotiate favorable pricing with their in-network doctors and hospitals, and insured patients seek out those in-network services – but there is a catch.

Balance billing takes patients by surprise exactly because the in-network process is so complicated. It is possible for a fully insured patient to go to an in-network provider and still receive a huge bill, one they may or may not be able to pay.

How Does it Happen?
The problem arises when patients seek services at in-network hospitals, only to have their care provided by doctors who are considered out of network. In this situation, the patient has no way of knowing that their doctors are out of network – at last not until they receive a bill.

The problem of balance billing is particularly egregious for patients being treated in emergency situations, but it can arise in non-urgent settings as well. Even when the insured do their part, researching networks and verifying eligibility, they can still be blindsided by an unexpected, and unaffordable medical bill.

Trump Administration Moves to Stop Balance Billing
Balance billing is one of the biggest issues in the health care arena, and one that the Trump Administration is trying to tackle. Of course Trump is not the first president to recognize the issue and try to tackle it, but patients hope he can succeed where others have failed.

So what is the Trump administration doing to put an end to balance billing, and what are the odds of success? Unlike many things the Trump administration has done, the move to eliminate surprise medical bills and tackle balance billing has gained bipartisan1 support. That bodes well for the success of future legislation, but there is still a long way to go.

There does seem to be a lot of grassroots support for the elimination of balance billing, and the measure has gained traction with some influential leaders in the House and Senate. Those congressional leaders are currently working with billing experts, health care executives, hospital administrators and others to seek a solution and chart a way forward.

Toward a More Affordable Future: What is the Solution?
From the creation of Medicare and Medicaid to the Affordable Care Act, politicians and pundits have been trying for decades to make health care more affordable. But despite some modest successes, the cost of health insurance and health care services has continued to rise, creating an affordability crisis for even middle and upper middle class patients.

Balance billing is perhaps the most egregious example of the health care crisis, since it hits patients who thought they were doing everything right. Every day, patients who thought they were fully insured open their mailboxes and find huge bills waiting for them, and for some the only way out will be bankruptcy.

The good news is that balance billing has finally gained the attention it deserves. President Trump and congressional leaders have acknowledged the crisis, and experts are working on legislation that could put this troubling practice to an end. And while no one knows what the future holds, there is now hope that those surprise bills could soon be a thing of the past.

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Feeding Tampa Bay

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