Balance Billing

[navangle]

What is the name of your state (only U.S. law)? Massachusetts

ok here is the short version. I went to the hospital, received a bill 1 month later, found out they billed the wrong insurance company so i filled out the bill with correct info. The hospital didn't submit the claim to new insurance until 3 months later, way past file time. Health insurance refused to pay and told me not to pay because it was hospital fault and they will just need to eat the bill. so i didn't pay and was sent to collections, called health insurance company they finally agreed to pay the contracted price, put the collection agency is still requesting remaining bal. I called my insurance again and they keep telling my its illegal, they are trying to balance bill. I now just saw that the bill has now been put on to my credit report. is there any recourse i can take, or did i just pretty much screw my self by listening to my health insurance company and not pay the bill. PS. this has been going on for almost a year.

[smcsween]

Balance billing rules and regulations vary by state and therefore you need to know what the specific laws governing Massachusetts. In most states, including to my knowledge Massachusetts although we focus primarily on Western states, balance billing is not prohibited by non-contracted providers. You seem to have indicated that the hospital was a contracted provider with your health plan.

At the very least this should be breach of contract and the hospital should be prohibited to balance bill by the contract that was signed by the hospital with your health insurer. Most insurers are smart enough to put a clause to this effect into the contract with the hospital or physician. Many states (although it seems that in Massachusetts balance billing is prohibited by law only for Blue Cross, Blue Shield and Medicare) also specifically prohibit by law the practice of balance billing a patient any amount above and beyond that which is contracted by the provider with the plan. For example, in California the law that prohibits balance billing patients of a contracted payer is called the Knox-Keene Act.

I would suggest contacting the hospital first to see if you can get them to call off the collections agency. You may also contest anything that is listed on credit reports with the three major credit agencies. You may also want to investigate via a local Massachusetts health care attorney that specializes in medical billing or reimbursement law to determine the laws of Massachusetts.

Sean McSweeney
Cobalt Health
medical billing company