![]() ![]() Is it legal or ethical? The legal part can be the main issue when physician’s and licensed practitioners are required by law in most, if not all states to at least attempt to collect patient co-pays, co-insurance and deductibles. This practice is common protocol in veterinary medicine and dentist. Is this balance billing? Technically no since you are only billing what the insurance has applied to patient responsibly. This is where the main issue and complaints lie. There are some providers that have opted to bill that entire amount to bill to the patient directly. ![]() However, when an out of network claim is submitted, most insurance companies may show an “allowed amount” but they will also put the remaining balance to the patients “responsibility”. This is an easy concept when talking about in-network claims since the insurance company clearly defines the allowed amounts and the amount owed by the patients. Is this really a national issue or just a media and hospitals propaganda campaign to steer away from other issues? Or is it an effort to shame everyone into becoming in-network? I am sure you have seen the latest efforts by states like New York, Florida and Virginia to outlaw “balance billing” but we really need to look at what is balance billing, who is really involved, who is at fault and how can it be fixed?īalance Billing is defined as a provider that bills a patient for the difference between the provider's charge and the insurance allowed amount. So what is surprise billing? Just because someone didn’t understand or didn’t hear when they were told, that doesn’t mean the surgical assistant is trying to do “surprise billing” in hopes to get something past the patients and steal money that isn't earned.
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