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What is balance billing and how does it lead to medical debt?

On Behalf of | Aug 18, 2016 | Medical Debt

Balance billing occurs when certain costs of medical treatment you receive are not covered by your insurance, even if the facility in North Carolina you were at was in-network. This practice is much more commonplace than you would think. According to Slate Magazine, one two-year survey found that of those people with a private health insurance plan, 30 percent were hit with a surprise medical bill.

You may be on the receiving end of a bill balance when the in-network hospital you were treated at contracts out some of its services. It is estimated that this practice takes place in 65 percent of emergency rooms across the country. Because people who are treated in emergency situations do not have the time or ability to give consent, they have no control over whether the person who treats them is an in-network provider.

For example, say you were admitted to a hospital for symptoms of a heart attack and you required surgery immediately in order to save your life. While the hospital and the surgeon on call who performed the surgery were both in your health insurance network, the anesthesiologist was not. Therefore, you could expect to receive a hefty bill from the anesthesiologist for his services.

Depending on your plan, your insurance company may cover none or only a portion of the amount, leaving you on the hook for the balance. While some states have taken measures to prevent this practice, such as prohibiting balance billing when the situation is a true medical emergency, there are many ways for providers to get around them and certain types of plans may be exempt from those protections.


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