Here`s an example of what balance settlement looks like: Large bill surprise typically occurs when a patient unknowingly receives services from an off-grid provider – for example, an off-grid radiologist at a network hospital – who has not agreed on discounts with an insurer. Insurers pay much less to out-of-grid providers than to providers in their network, leaving a higher bill for the patient in case the provider sends a residual bill. In 2018, MID received approximately six complaints regarding air and ambulance billing and received over $50,000 in feedback for consumers. In 2019, we received seven complaints related to ambulance thefts and received approximately $150,000 in return. “Something gets lost in communication, in messaging,” Fuller said, acknowledging that while Mississippi`s anti-balance law offers some protection to consumers, it`s not enforced consistently. Currently, Mississippi health care providers are violating state laws by “balancing” patients. This occurs when a provider charges a patient the difference between the initial fee and the amount paid after insurance benefits are awarded. Once the supplier accepts this payment, state law states that the invoice must be paid, even if the supplier has only received $500. If the provider tries to recover the remaining $500, it would be a “balance invoice” — a practice prohibited by a state law passed in 2013. One concern — a sort of tick 22 — is that if patients and their advocates start forcing providers to forgo balance sheet settlement, off-grid providers may choose to opt out of insurance assignments altogether. Then they could charge the patient the full amount.
In many states, credit settlement laws state that patients do not have to pay balance bills, but they do not prohibit providers from charging credits. If a patient does not know the law, he is likely to pay the bill he was not obliged to pay. “You shouldn`t have to spend money, hire a lawyer to write a letter,” Chism Mississippi told Today before the start of the 2019 session. You don`t have to. But Mississippi`s anti-pay billing does not distinguish between types of networks, so as long as the provider accepts insurance payment, “the payment is considered a full payment to the provider, who may not charge or collect any amount to the insured beyond that payment, other than deductible, co-insurance, co-payment or other fees for equipment or services. which are claimed by the insured and which are uncovered benefits. ” says in the law. In 2018, the MID received approximately $30,000 in return for consumers. In 2019, there were 10 complaints with about $25,000 for consumers. So far in 2020, the MID has received two complaints regarding the credit statement.
Mississippi is one of 21 states — and one of the few states in the Southeast — that have laws that restrict balance regulation. “The problem is twofold,” said Roy Mitchell, director of the Mississippi Health Advocacy Program. “A lot of people don`t know exactly what balance settlement is. Once installed, they don`t know where to go, how to get help. Related: After UMMC Admits Emergency Billing Is Unfair, Questions Remain About Changed Policies The law does not define a patient`s recourse when they receive a balance bill. Medical billing “in La-la-Land”: UMMC changes policy as part of investigation into expensive visit to emergency doctor In addition, consumers have to pay tens of thousands of dollars because air rescue providers are often not part of the insurance company network. The average cost of an ambulance bill is $36,000.00. Around the time the Anti-Balance Regulation Act was passed, legislators were considering another bill called the “any willing supplier” law. It would have required insurance companies to enter into a contract with any provider who wanted to be on their network. Although balancing regulation is prohibited by state law, the confusing nature of health care and insurance leaves patients vulnerable to predatory practices, health care advocates say. In addition, many people are unaware that the Anti-Balance Regulation Act exists or how it should be interpreted.
The Attorney General`s Office told Clarion Ledger that it accepts complaints about the settlement of balances processed through voluntary mediation. However, if the supplier refuses to use mediation, the Attorney General`s Office refers the consumer to a court or private lawyer.