Balance BillsAt some point, most of us end up in the vinyl-gloved hands of a hospital staff.  If you are reading this blog there is a good chance you’ve been there too, and recently.  Hopefully you emerged from the facility in better shape– body, mind, and soul– than when you went in.

Bills, Bills, Bills

Financially however, it is likely to be another story.  Because even if you have health insurance (and we sincerely hope you have it) you will receive a hospital bill for some portion of your stay.  That bill will probably be the first of many.  The doctor, the radiologist, the laboratory– all the providers who treated you during your hospital stay can belong to their own organizations which bill separately.  After you leave the hospital, bills can arrive from providers you’ve never heard of months, or even years later.  You may be cured of your injury only to find yourself suffering from another ailment, the acute fear of going to your mailbox!  Those bills are expensive and confusing.

And sometimes, they can be flat-out-wrong.  If you receive a bill for the difference between what your insurance has paid and a provider’s “retail” price, that’s called balance billing.  In Colorado, the practice is illegal if you have a state-regulated health insurance plan.  To see if you have a state-regulated plan, check your insurance card.  If you see DOI (Division of Insurance) or some variation, you are fully entitled to protection under state law:

  • It is illegal for a provider to charge you an amount above what they have agreed to accept from you insurance company. C.R.S 10-16-705(3).
  • It is illegal for an out-of-network provider working at an in-network facility to charge you out-of-network prices. C.R.S. 10-16-704(3).

If you have a state-regulated plan and you receive bills like the ones described above, you are not required to pay them.  Your provider is supposed to accept payment from your insurance company (plus any copays and deductible amounts your contract specifies) and be done with it.  No more bills.

Dishonest Billing

However, Colorado law does not stop an unscrupulous billing department from sending you a bill you don’t actually owe.  If you don’t pay, that bill can go to collections, and you can find yourself in court.

Be Prepared

Your best defense?  Know the law.  If you receive a bill you think may be incorrect, contact your insurance company first.  They may not have received a bill from the provider at all.  If you continue to receive bills you don’t owe, send a complaint to your insurance company and the state.

There is no national law against balance billing, and only nine states ban it completely. As healthcare reform inches its way through the system, we can only hope balance billing will be given a good dose of antibiotics and snuffed out for good.  When we are sick we need to heal, not worry about being fleeced.

Article by Molly Fuscher

If you need a Denver Insurance Bad Faith Lawyer, contact Shafner Law for a free consultation.