What is Surprise Medical Billing ?

When people have medical problems, they generally find in-network providers for their insurance.  But sometimes situations where patients are unable choose which provider to choose and they dont understand on choosing the in network providers, and thus end up unexpectedly receiving care from an out-of-network provider. While patients typically select an in-network hospital and lead doctor for planned hospital care (like a scheduled surgery or the birth of a baby) and sometimes even choose a hospital in emergency situations, they do not choose every member of their care team. Instead, hospitals direct ancillary providers like anesthesiologists, radiologists, and emergency room doctors, to play a role in the care that the patient receives.  These providers may be out-of-network even though the hospital is in-network. And in other emergency situations, patients may be taken to the nearest hospital, whether or not that hospital is in-network, and ambulance transportation may also be out-of-network.

When patients receive care from out-of-network providers that they did not choose, they may receive a “surprise” out-of-network bill.  The insurance company will often pay some amount to the out-of-network provider, but typically less than the provider’s list price (or “charge”) for the services. In many such cases, the provider then “balance bills” the patient for the difference between their list price and the insurer’s payment.

Now that we understand what is Surprise Medical Billing lets discuss some key factors

Surprise medical bills impact a significant amount of emergency room visits

The prevalence of surprise medical bills continues to increase

Some research says implementing payment standards to address the issue could have negative consequences

Other research says the policy is working and strengthening provider networks

The government is taking action to prevent surprise medical bills

Let me know your thoughts about surprise medical billing and if you have any questions or query on the same. 

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