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Insured Patients Wrongfully Billed through Balance Billing

07/09/2012 — Under Connecticut Law, it is illegal for any health care provider to request payment from a person who has health insurance (other than a co-payment or deductible) for medical services covered under a managed care plan. Unfortunately for the patients, medical providers and their billing services largely ignore this statute. 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 and this practice is unacceptable. One of the reasons patients get health care insurance is to have insurance companies negotiate health care costs on behalf of their insureds, leaving the patient out 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 or not 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.

Still, it can be difficult for a patient 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. Medical providers often trick patients into paying by sending them bills that say something like, “If we are unable to obtain payment from your insurance plan, any remaining balance will be your responsibility.” The statute was written to outlaw medical providers sending bills to patients for services they know are covered by health insurance, yet the medical providers still try to get around it.

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 work out their differences on their own and leave the patients out of it, for that is what the law requires.