(WAVY) — “These could kill people. This could be a reason that people don’t get their medication — because they’re trying to pay a bill off.”
Former Virginia resident Pam Myers is talking about surprise balance billing from medical providers, and she ought to know.
Myers was in South Carolina in 2018 when she had a stroke. She was treated there, and then got the bill when she returned to Virginia. It totaled $75,000, leaving her to pay $60,000 out of pocket.
“I thought I was gonna have another stroke when I opened that,” she said about the bill.
She was balance billed for care by specialists.
“When I saw it, I thought I was gonna die. I mean who can pay that?” she asked.
The Patient Advocate Foundation in Hampton resolved the issue, and Myers didn’t have to pay any of that huge surprise balance bill. CEO Alan Balch says another common scenario for balance billing is a planned procedure when someone on your medical team is out-of-network.
“You may schedule a surgery at a facility and it may be in your network, but they may bring in a radiologist [who is out-of-network]. They may end up sending you the balance of the bill of what your insurance company wouldn’t cover,” Balch explained.
So the patient would get caught in the middle of what Balch calls a “really heavy burden for the patient to bear.”
“Patients don’t have to worry about that. How the bill is settled – patients are no longer involved in that dispute,” Balch said.
Instead, the system will borrow a page from major league baseball and its arbitration system. The provider and health plan will make their pitches as to what they think the rate should be, and an arbitrator will decide.
Balch says it’s always best to check with your health plan ahead of time, to see what’s covered for both scheduled medical procedures and emergency care as well.
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