Hospitals and Physicians Prevented From “Balance Billing”

Personal injury lawyers frequently spend significant time every case dealing with medical liens. These liens can be asserted by any medical provider or insurer who provided or paid for care, but has not been paid for such care. Usually the lien attaches if there is a monetary award from a third party.

Under a new California law, hospitals and physicians are prevented from billing the patient for sums that are not paid by insurance. “Balance billing” occurs when an insurance provider, under a contract with a hospital or physician, only pays a percentage of the total bill. In some cases, the hospital or physician would then go after the patient for any balances owed, even though the patient has full health coverage.

If this sounds surprising, or unfair, it is. Imagine being a faithful insured, paying your premiums, and then having to go the emergency room only to find that your insurance company won’t pay for all of the treatment. This is the surprise many personal injury victims get after suffering a harm.

This is really a dispute between hospitals and insurance companies. The insurance companies claim that the hospitals over-charge for the services provided, and the hospitals claim that insurance companies usually pay far less than what is reasonable and customary. The victim in this immoral tussle is too often the patient.

This is a good law that no doubt will be promptly attacked by both the insurance companies and the hospitals.