Balance Billing and Self-Funded Medical Ins. (EPO's)

[StarkRaven$]

"A California law that took effect Jan. 1 aims to protect consumers from such enormous bills for out-of-network air ambulance services. The measure limits what consumers owe if they’re transported by an air ambulance that’s not part of their insurance network to the amount that they’d be charged if they used an in-network provider. The health plan and the air ambulance provider must then work out payment between themselves.

But the new law won’t protect consumers like Hoechlin, whose health plan isn’t regulated by the state. Matt’s employer pays its workers’ medical claims directly rather than buying state-regulated insurance, a common arrangement called “self-funding.” Self-funded plans are regulated by the federal government and generally not subject to state health insurance laws.

In this regard, the new air ambulance law is like laws in California and other states that protect consumers from surprise medical bills: They don’t apply to residents in federally regulated health plans. Those plans cover about two-thirds of people who get insurance through their jobs nationwide." ~ California Healthcare

 

With an EPO (self funded) insurance plan, balance billing may result for less extravagant but routine procedures such as anesthesiologists, lab work, etc. Even if you are referred to a in-network facility. It happens when say, the anesthesiologist who is out of network, is working in the in-network facility and the EPO doesn't cover the charges. The patient is billed separately and on the hook for the full amount of the out of network physician. HMO's are protected from balance billing CA.

 

https://californiahealthline.org/news/loopholes-limit-new-california-law-to-guard-against-lofty-air-ambulance-bills/

 

 

[StarkRaven$]

2 hours ago, StarkRaven$ said:

"A California law that took effect Jan. 1 aims to protect consumers from such enormous bills for out-of-network air ambulance services. The measure limits what consumers owe if they’re transported by an air ambulance that’s not part of their insurance network to the amount that they’d be charged if they used an in-network provider. The health plan and the air ambulance provider must then work out payment between themselves.

But the new law won’t protect consumers like Hoechlin, whose health plan isn’t regulated by the state. Matt’s employer pays its workers’ medical claims directly rather than buying state-regulated insurance, a common arrangement called “self-funding.” Self-funded plans are regulated by the federal government and generally not subject to state health insurance laws.

In this regard, the new air ambulance law is like laws in California and other states that protect consumers from surprise medical bills: They don’t apply to residents in federally regulated health plans. Those plans cover about two-thirds of people who get insurance through their jobs nationwide." ~ California Healthcare

 

With an EPO (self funded) insurance plan, balance billing may result for less extravagant but routine procedures such as anesthesiologists, lab work, etc. Even if you are referred to a in-network facility. It happens when say, the anesthesiologist who is out of network, is working in the in-network facility and the EPO doesn't cover the charges. The patient is billed separately and on the hook for the full amount of the out of network physician. HMO's are protected from balance billing CA.

 

https://californiahealthline.org/news/loopholes-limit-new-california-law-to-guard-against-lofty-air-ambulance-bills/

 

 

Medicare Protections:

https://www.aarp.org/ppi/info-2017/medicare-protection-for-consumers.html

[StarkRaven$]

9 hours ago, StarkRaven$ said:

Medicare Protections:

https://www.aarp.org/ppi/info-2017/medicare-protection-for-consumers.html

Detailed state laws addressing medical balance billing:

 

https://www.commonwealthfund.org/publications/maps-and-interactives/2020/sep/state-balance-billing-protections?redirect_source=/publications/maps-and-interactives/2020/apr/state-balance-billing-protections

[StarkRaven$]

Bump

 

@ the legal people on this board, was my interpretation of CA's law correct in my first post on balance billing? I am trying to be proactive for future unforeseen medical bills.  

 

Thank you in advance