Comments on: Balance Billing Update

By: John

John — Fri, 27 Mar 2009 23:21:10 +0000

I have the exact situation as Daisy mentioined. Does anyone have any advice. Please help.

By: Brian

Brian — Wed, 18 Mar 2009 23:23:35 +0000

The California Supreme Court’s ruling interpreted a provision that applies only to members of HMO’s. Providers bill members of non-contracted insurance companies, indemnity plans, ERISA plans, and PPO plan for amounts unpaid by the insurance company.

Brian

By: Daisy Meeker

Daisy Meeker — Mon, 09 Mar 2009 03:19:06 +0000

My health insurance in Florida has told me that I do not have to pay the balance that my health provider has asked me to pay. They said they have a contractual agreement with them and it wasn’t met so they do not have to pay them. I payed my co-pay but United Healthcare never paid the provider due to the agreement that if they didn’t bill them for an office visit during their alloted time they lose the payment and it has nothing to do with me. Well that’s fine for them but in the meantime they are ruining my credit!

Can you please give me some advice?

By: Stephen Ambrose

Stephen Ambrose — Sat, 07 Feb 2009 13:55:36 +0000

Adam,

I have filed for several patents on a software method for ‘compensatory invoicing’. This is a trademarked term, which describes health payers being able to secure a private lien between themselves and their patients.

The lien, stipulates specifically that if the patient HAS health insurance and the provider bills the health insurance, that the provider HAS to accept what the insurance pays EXCEPT, if the patient chooses to use the provider’s billings to a 1st and/or 3rd party payer.

Thereby, the provider secures the balance of their bills, not directly from the patient, but if and only if, there is a first or third party who has been billed again, through the collateral source rule.

This is different from balance billing because the monies sought are from a second billing with the same bills and not directly from the patient. Moreover, health insurers generally have no juristiction over state laws, allowing providers and patients to enter into a lien agreement.

However, compensatory invoicing does not work in all 50 states, because some states either preclude a provider’s lien against 3rd party if they have already been paid by health insurance OR some states have state statutes stating levels of pay that constitute “reasonable and fair” are determined by general insurers or Medicare levels.

Anyway, I do not agree with balance billing…but I do believe that doctors and providers should be able to be paid their full charges in cases of patients and attorneys using BOTH health insurance and another payer, when double dipping with the provider’s bills – at the full fee level.

I have greatly enjoyed reading your blog Adam…and will continue to be a regular subscriber.

Best,
Steve