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Some surprises excite and bring joy, others catch you off-guard, fumbling to pick up the pieces. Surprise billing falls in the latter category. Surprise billing isn’t new, but it’s certainly gained a lot of attention over the past several months. Unfortunately, there’s no real answer that helps everyone. 

What is Surprise Billing?

Surprise billing happens when a patient receives a large, unexpected bill from a medical provider, most often an out-of-network provider they used. Sometimes the patient unknowingly used an out-of-network provider, creating even more confusion and frustration when they get stuck with a huge bill they assumed their insurance was covering. Balance billing and cost-sharing both come into play, creating an opportunity for insured Americans getting hit with two additional bills. 

Cost-sharing

Cost-sharing refers to the amount you pay out of pocket versus what the insurance company covers. Your deductible and copayments fall into this category. Balance billing refers to the balance of the bill your provider gives after they’ve received the insurance money. 

The fight over surprise billing puts the American healthcare system in the spotlight and highlights some of its downfalls. Doctors want, need and deserve to be paid for the services they provide, patients deserve fair coverage from their insurers, and the insurers push the loopholes for paying out for services provided. According to Health Affairs, average surprise bills surpass 600 dollars, with many being thousands of dollars. 

Protecting patients

The fight has gone to Washington and, like many other hot topics, there isn’t a clear answer to help all parties involved. How do you protect patients from massive, unfathomable bills that the average American might never be able to pay off while protecting doctors and providers from getting shorted? 

While there may not be a clear answer, having a relationship with a solid medical billing service can help navigate these treacherous waters. A dedicated and highly trained staff knows how to handle insurance claims and works for both you and your patients. While it’s not easy to know how to handle all of the issues facing the average American patient, we are able to assist in answering the tough questions and fighting for both sides to come to the fairest conclusion.