The source listed at the end of this post provides another example of medical billing abuse by health care providers, medical billing services, and health insurance companies. Under Connecticut law, it is illegal for any “health care provider to request payment” from a person who has health insurance, other than a copayment or deductible, for medical services covered under a managed care plan. (See Connecticut General Statutes Section 20-7f.) Unfortunately, this statute is largely ignored by medical providers and their billing services, to the detriment of patients. This practice is often called “balance billing” in the medical billing industry.
In Connecticut, medical providers routinely bill patients for services covered by medical insurance, likely depending upon a strained interpretation of this statute. Of course, the statute provides certain technical definitions for phrases such as “request payment,” “Health care provider” and “managed care organization,” and even refers to patients as an “enrollees.” But even though the statute is written in legalese, the language generally aligns with the lay reading of the statute, which is clearly to outlaw medical providers sending bills to patients for services they know are covered by health insurance.
It is difficult for patients to assess when they have been wrongfully billed, because of the varying co-pays and co-insurance requirements under different health insurance policies. Also, most patients are not aware that their medical provider has signed a contract with their insurer promising not to “balance bill” the patient. Patients actually have no right to a copy of this contract. So when a patient gets a bill that references their health insurer but says something like, “If we are unable to obtain payment from your insurance plan, any remaining balance will be your responsibility,” it is understandable that the patient is often duped into paying, just to avoid any potential impact on their credit rating if they are ultimately responsible for it. Under the statute, however, any type of request for payment by a medical provider to an insured patient for a covered service may be an independent violation. Worse yet, some patients are even getting sued by the health care provider, without regard to whether they have insurance.
There are many good reasons for preventing this type of patient harassment. First, in theory, that is one of the reasons patients get health insurance in the first place – to have the insurance companies negotiate health care costs on behalf of their insureds, without leaving the patients in the middle of the fight. This, in turn, is supposed to lower costs as a whole. Also, it is wholly unfair for emergency patients, who have little or no choice as to who their medical provider will be, to receive bills from providers who are under an ethical obligation to respond to their need regardless of whether they have insurance. Finally, for those who have insurance, it is outrageous that their doctors are able to use the patient as a negotiating tool to pressure the insurance company to pay faster or more fully.
Patients should not be placed in the middle of this fight for money by their health care providers. Rather, medical providers and health insurance companies for patients should be required to work out their differences on their own, and leave the patients out of it. And that is what the law requires.
Source:CBSChicago, “2 Investigators: Are Hospitals Double-Billing Some Patients?” Jun. 13, 2013.