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Balance Billing Report

Out of Control

Patients Are Unwittingly Subjected to Enormous, Unfair ‘Balance Bills’


April 16, 2014 — One reason health care bills can soar out of control is a practice known as “balance billing,” which refers to bills for the difference between the amount that an insurance company is willing to pay for treatment and a provider’s total charges. Providers who are not members of a patient’s insurance network have charged patients as much as 9,000 percent of what Medicare would have paid for the same procedure.

Patients can be subjected to balance bills despite making their best efforts to avoid them. For instance, they might receive care at an in-network facility, only to find out later that an out-of-network doctor — even a pathologist with whom the patient never interacted — was involved in their treatment.

This paper outlines policies that could be implemented at the state and federal levels to protect patients from being unwittingly subjected to mammoth balance bills.