Like the tortured Danish Prince in Shakespeare’s Hamlet, contemplating whether to live or not to live, the medical billing offices of many a clinic are in a dilemma when faced with the prospect of balance-billing patients, who have availed themselves of a medical service with providers considered to be out-of-network by their health plans. The very term balance billing has come to bear sinister connotations for both patients and providers alike, what with nearly 45 states prohibiting it (for in-network providers); and any physician balance billing a patient is considered to be a penny-pinching shrew out to siphon out patient’s hard-earned money.
But then one can safely say that the issue’s treatment has been so overwrought and so steeped in feverish melodrama that it makes your average soap seem like an exercise in existential angst. The fact remains that balance billing is essential in some cases and your medical billing personnel or medical billing vendor should not shy away from billing the patients in such instances.
Balance-Billing, in simple terms, means that you charge the patient over and above than what the patient’s health plan has agreed to pay for a particular service.
Although it is illegal to do this in many states for in-network providers, there are instances where this can happen. They are:
1. Patients availing emergency services from out-of-network providers.
2. Patients availing surgeries not covered by their health plans (e.g. cosmetic surgery); thus the cosmetic surgeon is not bound by any credentialing agreement.
3. When you treat patient’s emergently and don’t make time to get prior authorization from their insurances for any particular service for which their health plan mandates prior authorization.
Although balance-billing may not be illegal in the above instances, still such cases has to be dealt with the utmost sensitivity it deserves. It thus goes without saying that only a seasoned medical billing company like Billing Paradise can handle such delicate cases of patient billing without ruffling any feathers or resorting to collection agents. Our guiding principle in such cases is the EOB or Explanation of Benefits, with which one can lucidly explain to the patient why the situation arose in the first place. The rest, we leave it to our smooth-talking AR callers.
Call us at 1-888-571-9069 for a telephonic rendezvous about this or any other thorny medical billing issue that has been troubling you.
