Colliton

Overcharges

The KHN team sent the itemized charges to experts in the field who reported they believed charges were excessive.

Balance Billing

In Drew’s case, the outof-network hospital and the insurer disagreed on what was a reasonable price for the care. When the insurer paid only $55,840, the hospital then demanded the patient pay the difference. This is a practice referred to as “balance billing.”

Balance billing is prohibited, controlled or limited to certain conditions in some states. That was true in Texas where Drew received his care. However, it had an exception.

Health coverage in his case came through his large employer which was self-insured but used an outside health insurer, AETNA, to administer the fund. His employer did not fit within the rule in Texas which applied to health insurers. Note that, if your insurance is Medicare and a Medicare Supplement, there is some protection. This case involved insurance through a large employer, not Medicare.

What To Do

The article recommended that, when faced with a large balance bill or surprise bill situation, not to rush to pay the bill immediately and allow the process to play its course through the insurance companies.

That might be easier said than done since one concern is reflection on your credit score. However, easier than the type of charges stated here. Also, ask for an itemized bill. Another recommendation was to talk to your employer’s benefits department or to the State Insurance Commission regarding legal protections.

As best I can tell, legislation was introduced in Pennsylvania for balance bill protection but not passed at this time. Tell anyone involved that you are disputing the bill.

Finally, what did Drew have to pay? When the dust settled and KHN investigated, according to the article, the hospital stated it was willing under its “financial assistance discount” to settle for $782.29 to resolve the $108,951 balance if Drew submitted a written request. At the time of publication he did not believe that should be owed. Janet Colliton, Esq. is a Certified Elder Law Attorney and limits her practice to elder law, retirement and estate planning, Medicaid, Medicare, life care and special needs at 790 East Market St., Suite 250, West Chester, Pa., 19382, 610-4366674, colliton@collitonlaw. com. She is a member of the National Academy of Elder Law Attorneys and, with Jeffrey Jones, CSA, cofounder of Life Transition Services LLC, a service for families with long term care needs. Tune in on Wednesdays at 4 p.m. to radio WCHE 1520, “50+ Planning Ahead,” with Janet Colliton, Colliton Elder Law Associates, and Phil McFadden, Home Instead Senior Care.