Wednesday, February 12, 2020

Chaney Pushes Balance Billing Reform

Insurance Commish Mike Chaney issued the following statement.


Over the past several years, my office has seen an uptick in balance billing, also called surprise billing. Imagine opening your mail to find a bill for hundreds of dollars for a doctor visit that you believed was covered by insurance. That is what happens to some Mississippians, often seeking emergency medical care, and in many cases, it is illegal.

A Mississippi law (Section 83-9-5) which passed in 2013 prohibits balance bills where the insured assigns his or her benefits to the medical provider. In the simplest terms, balance billing occurs when you are charged the difference between what a provider charges for services and what your insurance actually pays the provider. I have set out an example of balance billing, in detail, near the bottom of my letter.

What you should know is that, although the law prohibits it where an assignment of benefits occurs, some providers fail to comply. Rep. Gary Chism (R – District 37) has authored House Bill 95 and I fully support this measure. It amends the 2013 law to give my office the power to adopt regulations and resolve disputes between healthcare providers and consumers.

I hope that you will also support HB 95 after you consider the impact of balance billing and the amount of money involved. The Mississippi Insurance Department (MID) began receiving calls about balance billing in 2015. Calls increased significantly in 2018.

In 2018, the MID recovered approximately $30,000 for consumers. In 2019, there were 10 complaints with approximately $25,000 recovered for consumers. So far in 2020, the MID has received two balance billing complaints.

Additionally, consumers are being balance billed tens of thousands of dollars because air ambulance providers are often not in the insurance carriers provider network. The median cost of an air ambulance bill is $36,000.00.

In 2018, the MID received about six air-ambulance balance billing complaints and recovered more than $50,000 for consumers. In 2019, we received seven air ambulance-related complaints and recovered approximately $150,000.

This is an example of what balance billing looks like:

A patient enters a network hospital for a surgical procedure. The anesthesiologist providing services for the procedure is not in the patient’s healthplan network. The patient would not be aware of this fact until they receive a bill from the anesthesiologist. Because the anesthesiologist is an out of network provider, the insurance carrier will pay the out of network rate.

The anesthesiologist’s total charge is $1,500. The patient’s insurance company’s non-network rate is $600. The patient will receive a bill for $900 (assuming the patient has met their healthplan yearly deductible).

House Bill 95 passed in the House of Representatives last week with overwhelming support but has since been recalled for reconsideration. I hope to see HB 95 passed, giving existing state law the teeth it needs to save money for Mississippi insurance consumers.

As always, I urge you to call on my office if you have questions about insurance or balance billing.

E-mail us at consumer@mid.ms.gov or call 1-800-562-2957.




19 comments:

Anonymous said...

Medical lobbyist at work sending this bill back for reconsideration. Take all lobbyist out & shoot them!

I got wind of a medical expense to the tune of $ 9500.00 for a DNA analysis of a tumor. It showed up on my quarterly Medicare statement. I'm on a fixed income & can't afford this. I have Medicare, Blue Cross Blue Shield, & a veteran qualified for VA Medical care & I still see charges like this. Go figure.

Anonymous said...

Imagine the IN NETWORK facilities that are owed hundreds of thousands of dollars from the insurance companies that Mike Chaney's office won't hold accountable. I'm talking rural facilities.

Anonymous said...

I had no idea this even existed. It sounds like a great idea and puts consumers on equal footing regardless of who provides the service.

Of course some providers could just opt out of direct billing to the insurance company and try to collect payment from the patient. The law already says if the patient received the benefit then the service provider must be notified. A provider like an air-ambulance that has a history of high balance billings is going to have to weigh out if it is better to settle for what the insurance company says is reasonable and take just that versus what they've actually been able to squeeze out of their clients.

I can see if a lot more people know about this and take advantage of it, some services in rural areas that are less frequently used with significant down time between clients will be discontinued. Insurance company set reasonable rates will need to be set at a level that ensures state-wide coverage and not just in urban areas.

Victor Fleitas said...

Mr. Cheney's tenure as Commissioner of Insurance has been one of Mississippi's political bright spots. I commend him for bringing this unlawful practice into the light and seeking the power to enforce the law on behalf of consumers.

Anonymous said...

This is an important issue for everyone.If you are on a company group plan, an individual plan or on Medicare you are subject to balance billing. Your child has an ankle injury, the ortho doc puts them in a boot. Oops the boot maker is not in your network so it’s not covered.

Anonymous said...

So, is the insurance commissioner saying that it is illegal for an anesthesiologist who has no contractural agreement with the insurance company to charge the patient the difference between their private fee and the insurance company fee?

Anonymous said...

If I have done the research to know that the hospital and doctor performing my surgery are in-network. Then I should not be receiving anesthesia from an out-of-network anesthesiologist. These "surprise bills" are very common and can leave patient with a large bill.

Victor Fleitas said...

@ 9:26 AM: Air Ambulance companies got Congress to pass legislation which permits them to balance bill patients for the retail price of their service. North Dakota passed a law to end the practice and had the law struck down by a federal court which said States cannot regulate air ambulance services.

@ 10:49 AM: Balance billing only arises in situations where a patient is insured. If the physician is in network or accepts that insurance that physician agrees to be reimbursed at the insurance carriers approved fee for service. The insured is a third-party beneficiary to that agreement. The physician's effort to balance bill the patient after providing the service violates the agreement with the insurer and Mississippi law. All the Commissioner is saying is that he wants the authority to enforce the law on behalf of patients who file complaints.

Anonymous said...

@10:49 When you go to an In-Network hospital, you expect the services received in that hospital to be considered In-Network. Patients shouldn't be expected to ask every doctor treating them if they are in-network.

Anonymous said...

@10:49 Only if that anesthesiologist accepts insurance assignments. In other words, if that anesthesiologist agrees to direct bill the out-of-network insurance company and accept payment directly from the insurance company, then yes they are not allowed to bill for more than the standard rate for the procedure.

Of course, any provider that doesn't do direct billing for covered procedures is going to have a hard time staying in business. The alternative is to have the insurance company send the check directly to the patient and then bill the patient for the full amount. The confusion and frustration in that situation would be massive.

Anonymous said...

Speaking of Air Ambulance...this came up on this blog a couple of weeks ago and I was roundly chastised for criticizing the commercials for this ripoff.

As a result, I contacted the one serving the Delta and got answers from the home landing strip over in Arkansas (or it might have been Louisiana). And yes, according to my posts here, they are NOT dispatched by first responders unless you have a paid for contract with them.

The person on the other end of the conversation hem-hawed around for an hour about the value of their services and rapid response. But, fact is, if an ambulance, county deputy or volunteer fire department responds to your remote, rural emergency location in northeast Mississippi, and your situation is deemed critical, they will call air ambulance out of Jackson, not some outfit based in rural Louisiana. So much for your paid up transport-contract.

Anonymous said...

It’s evident that some making comments do not understand the issue. This bill is important and everyone is subject to being balanced billed.
Similar legislation has been padded in many states

Anonymous said...

Get SUM Mike! Why do I have to pay $350 to GI Associates, in network, prior to a procedure and that payment NOT show up my EOB? Something is fishy in Denmark! But what are you to do if NO ONE has enforcement authority for balanced billing by a provider?

Anonymous said...

When you look at what Medicare pays for various procedures it becomes evident to those who pay attention just what the procedures are worth and those with private insurance as a rule pay a great deal more than the fair price. And anesthesia in particular is a gold mine to the doctors who are not hospital employees but why are they not employees of the hospital?

All in all it has appeared to me that since the time of Evelyn Gandy the commissioner has been primarily concerned with protecting insurance companies for the same reason that Medicare has all the additional optional part, i.e., money, of course. Individual voters don't care about rip offs by government until it affects them individually but then the government doesn't pay any attention to individuals when they have a problem. Well the average individuals anyway.

But then it's just more corruption. No big deal.

Anonymous said...

We had this happen to us years ago. We used an in network OB and in network hospital. Our child was born premature and the NICU physicians were their own private group within the hospital. BCBS covered the delivery and nursery costs just as we had planned but we were left with a huge NICU bill.

Anonymous said...

@9:45 I bet I could tell you the hospital. It's been over 20 years, but that is our exact story. I wrote the doctor a letter explaining the circumstances and he very graciously killed the extra bill. It was very shocking and very unfair, considering we had taken great care to make sure the hospital was in network.

Anonymous said...

@5:16 I've had this happen a couple of times. The provider will run my information through BCBS and note that I still have $500 of my $1,000 deductible to meet. They will make me pay the $500 up front. The EOB only shows what the insurance company is responsible for. If everything works out right the EOB should show $500 of the procedure applied to your deductible, but the insurance company has no way of knowing or even caring what you paid to the doctor.

You'll just have to reconcile the provider's bills with the EOB and make sure what you paid equals what the EOB says is the patient responsibility. Never trust the doctor's office to do everything right.

What really is fun is when more than one provider is involved. I've had to pay the remaining deductible to two different providers and then fight for a refund later when one of their claims wasn't reduced by the deductible.

Anonymous said...

Go to the Canada model.

Anonymous said...

I didn't know I had a choice. Anything insurance doesn't pay, I wind up paying unless the provider 'agrees to accept assignment'.

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