Although medical providers are prohibited from billing patients for costs that aren't covered by Medi-Cal, California's low income insurance plan, patient advocates say they are receiving an increasing number of complaints regarding the practice known as balance billing, according to the Los Angeles Times.
Balance billing refers to instances in which healthcare providers bill for medical costs that Medi-Cal doesn't cover. Stephanie Lee, a supervising attorney at the Neighborhood Legal Services of Los Angeles County's health consumer center, tells the LA Times complaints of balance billing through her agency's help line have doubled in the last year.
But balance billing is often born out of misunderstanding, Georgia Burke, the directing attorney with Justice in Aging, tells the newspaper. Many providers that only accept Medicare don't realize that if they treat Medi-Cal patients, they must bill the program, not the patient, for whatever costs Medicare doesn't cover.
In one instance a 72-year-old woman was told halfway through her chemotherapy treatments that she owed more than $200 because her physician didn't accept Medi-Cal. Like others, she paid the bill out of pocket, but was forced to switch doctors.
Like California, New York recently enacted a law that will protect patients from balance billing, and sets up an independent dispute resolution for insurers and providers. In the past, insurers have clashed with hospitals over balance billing practices that charge exorbitant amounts for out-of-network services. In some instances, insurers like UnitedHealth have changed balance billing practices, leading to concerns that consumers would pay thousands in surprise bills.
- here's the LA Times article