09/09/2015    

HEALTHCARE NEWS

Out-of-Network Billing Fuels Provider-Payer Friction

 

One of the most contentious clashes between providers and payers is over billing for out-of-network medical services. This year, legislatures in at least seven states have considered creating laws to set firm ground rules for how much money physicians and hospitals can charge when they are not included in a payer's provider network. Charges above the in-network rate are called balance billing.

 

The sparks are flying furiously in New Jersey, where Hartford-based Aetna has sued a half dozen out-of-network physicians in recent years, alleging gross over-charging for services. "New Jersey is our primary play," says Elena Butkus, head of state government affairs at Aetna. "They have the highest charges in the nation." From Aetna's perspective, the commercial insurance carrier has an obligation to...

 

Editor's note:To read the complete article, click here.

 

Source: Christopher Cheney, MedPage Today [9/6/15]