Patient sues over balance billing

A man sued Washington University in St. Louis, alleging the university's doctors and other healthcare providers routinely overbill for medical services, the St. Louis-Dispatch reports.

The suit filed Friday asks for damages based on claims that thousands of insured patients have lost money as a result of the billing practices.

At issue is the common practice of "balance billing," where health providers charge patients the difference between their own [the doctor's] fee and what the insurer reimburses. Out-of-network providers resort to this kind of billing when an insurer's payment does not cover the whole fee for a service. By contrast, if both the patient and provider are part of the payer's network, the provider by contract will be okay accepting less than the regular fee for seeing patients in the network.

From a consumer's standpoint, it looks like the provider is charging different fees depending on who is responsible for the bill.

The suit alleges that balance billing, which is common among state healthcare providers and banned in some states, violates the Missouri Merchandising Practices Act, which forbids unfair or deceptive practices. It says that Washington University and other providers charged high prices to patients for "out-of-network" care, not fully covered by their insurance policies.

A spokesperson for the university did not comment on the suit.

The man who filed the suit was an insured patient who was hospitalized in 2008 at Barnes-Jewish Hospital. The hospital owner and Washington University later sued the man after he refused to pay for costs not covered by his health plan.

A spokesman for United HealthGroup Inc. noted that billing practices vary, because some patients have out-of-network benefits and others do not.

To learn more:
- read the St. Louis Post-Dispatch article
- read Dr. Lucy Hornstein's primer on balance billing