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Balance it Out

Working with consumers to explain and help resolve medical bills in collections is a complex process for accounts receivable management companies and their health care provider clients.  Add in the mix unexpected out-of-network charges on a consumer’s bill and all parties involved face challenges to find a solution.

State legislatures started to tackle the issue, known as balance billing, to prevent these charges from reaching the consumer after their bill is processed by a provider and insurance company. Bipartisan debate continues at the federal level to enact laws prohibiting balance billing.

A ‘balance bill’ is a term that refers to any time a consumer’s insurance pays part of the bill, yet they are responsible for paying the balance; and states with laws on balance billing indicate the circumstances when it is legal, according to The Commonwealth Fund.

Educate and Work Together

As lawmakers focus on the issue of balance billing at the state and federal level, it’s best for collection agencies in business partnerships with health care providers to learn together with the goal to help patients through the process.

In California, an amendment to the state’s health and safety code (added sections 1371.30, 1371.31 and 1371.9) AB 72, authored by Assemblyman Rob Bonta, D-Alameda, took effect July 1, 2017.  AB 72 applies to non-emergency care that is provided at an in-network facility but performed by a physician who is out-of-network with the patient’s insurance plan.

“The obvious problem that this has created is that it is difficult for the provider to know if the patient was in-network at the facility or if the services were part of some non-emergency treatment that would require AB 72 to be applied,” according to Courtney Reynaud, president of Creditors Bureau USA in Fresno, California, which works in medical collections.

Reynaud, who is also president of the California Association of Collectors Inc., said after the legislation took effect some provider clients stopped referring accounts to collection with charges that could potentially fall under AB 72.  Oftentimes, they had no mechanism to determine if the services were emergency or non-emergency and if the services were provided at an in-network facility.

Reynaud recommends staying informed on legislative issues and compliance through state and national medical associations such as the California Medical Association and Medical Group Management Association. Balancing Compliance California’s legislation is different than laws in other states and proposed bills at the federal level in that it doesn’t cover charges as a result of a patient’s emergency services.

For example, in Florida, legislation in effect since July 2016 protects patients from out-of-network charges at an in-network facility in emergency situations.  Before the legislation took effect, Matt Kiefer, chief officer of information, compliance and development at The Preferred Group of Tampa in Tampa, Florida, said his agency received medical accounts from unexpected charges due to balance billing.

“Covered charges, noncovered charges, coupled with high deductibles and copays can not only be confusing, but upsetting and only exacerbates the issue when out of network charges and balance billing

are allowed,” Kiefer said. “Legislation like HB 221 in Florida to prevent surprise charges helps the patient in an already uncomfortable position.”

If there is pending legislation in your state, or to stay informed about the topic at the federal level, Reynaud also suggests hosting a webinar for clients or coordinate office training for your provider client’s staff.  “The bottom line is to continue to train collectors to be empathetic when working with consumers with medical debt, especially when it comes to medical debt from surprise medical bills if there is not legislation in your state and the charges are from out-of-network providers.”

Last modified onThursday, 27 June 2019 17:37
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