Balance Billing—The charging of consumers the difference between what the health insurance carrier has negotiated on your behalf as fair and reasonable compensation and the hospital's full non-negotiated unregulated charge. A charge you a never told before you are given the medical treatment. We are seeing medical providers evade statutory and contractual protections by charging persons in auto accidents the full non-negotiated retail medical rate. Almost nobody actually pays “retail” for health services
- The “price” of health care services depends largely on who is paying.
- Health care providers contract with insurers to accept “negotiated rate” payments for medical services. This rate can be less than half of the retail amount billed. The reimbursement rate for Medicare patients is even lower still.
- The negotiated rate benefits all concerned. The provider gains access to a large pool of potential customers. The patient and the health insurer secure health services at a rate that it agrees with the insurer are fair and reasonable.
- However, this system creates an incentive for providers to circumvent the “negotiated ” rate if they think they can collect retail. This problem is particularly apparent when the patient has a tort claim triggering a liability policy. The provider can seek to seize some portion of the liability policy at the full, retail rate. Thus the medical provider may grab a large portion of a limited fund you will need to pay other medical bills or cover lost wages.
Keep in mind no one negotiates a fee for medical services except our health insurance carriers and Medicare, but for those negotiations, you pay whatever the medical providers tell you after the fact what is due. We do not do business that way in any other service, you know what you charge will be before authorizing work from, contractors, accountants, auto mechanics but not doctors and hospitals leading to outrageous and unjustified billing practice.
Ohio Statutes forbid medical providers from charging more than the negotiated rate they agreed to accept. Hospitals think they are above the law and are refusing to bill your health insurance company instead try to collect the full bill from you personally. Don’t take it! Demand the hospital bill your health insurance carrier, do not take no for an answer. Murray & Murray representing many clients in litigation against hospitals that have adopted this reprehensible practice of gouging their patients.