What is Surprise Billing?
What is Surprise Billing?
Surprise billing, also referred to as balance billing, occurs when a patient receives services that were believed to be covered in-network but were actually billed as out of network, resulting in higher medical expenses. Surprise billing can also take place when the patient’s private insurance does not cover the cost of services to the degree an individual estimated that they would. Rising in the United States, balance billing is among the top financial concerns among patients.
Balance Billing Prior to COVID-19:
Surprise billing started far before the outbreak of COVID-19 in our nation. In this long battle, patients have received alarming medical bills that they didn’t see coming. Under the Affordable Care Act, when a patient receives emergency care, private insurers are only required to pay rates that are "reasonable." Although, these rates can still be notably lower than what a provider is charging for services. Therefore, insurance providers can bill patients for the remaining amount.
The Impact of COVID-19 on Surprise Medical Bills:
COVID-19 took the United States by storm in March of this year and continues to grow as scientists and medical professionals search for a solution. The rapid rise and spread of the coronavirus led government and private insurers to quickly adjust and implement policies that addressed how COVID-19 services should be billed for. Treatment costs associated with COVID-19 have resulted in an equally rapid rise in surprise billing for patients across the country.
Testing and treatment for COVID-19 has left patients with alarmingly high medical bills from their providers. For patients who needed hospitalization for their treatment, the cost of services has risen for some to be over $30,000. The cost being monumentally higher for out of network services or uninsured patients. While some areas advertised free testing, patients were still left with a bill after certain locations started charging after a certain volume of people were seen.
The CARES Act and Balance Billing:
Due to the coronavirus outbreak, many hospitals, clinics, and practices are suffering financially. Record low patient volumes are leaving many medical organizations trying to make ends meet. The Coronavirus Aid, Relief, and Economic Security Act, or the CARES Act, is offering many of these organizations emergency financial relief. The stipulation of this contract is that providers cannot send COVID-19 treated patients any surprise billing. Although several states have long banned surprise billing, this new legislation is disrupting the history of this billing method for many providers across the country.
The Importance of Price Transparency
While efforts are being made to eliminate the practice of surprise billing during COVID-19, there are tools that can help patients better prepare for their medical expenses down the line. Price transparency tools in quality billing software can help your patients know what to expect when they seek services from their providers. While difficult to calculate during an emergency, price transparency tools can help your patients prepare for the cost of services, driving more patient payments into your organization. The right tool can help calculate what a patient's insurance will cover as well as the patient’s estimated out-of-pocket cost for services, giving them a complete picture of the cost of their care before services are rendered.
A quality vendor will always be up to date on the latest changes in billing codes that apply to your COVID-19 services and more. To learn more about how a qualified vendor can help your patients avoid surprise billing/unexpected medical costs, click here.
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