Illegal Medical Bills and How to Fight Them

States Taking Action
A handful of states, including Colorado, Florida, Maryland and Wisconsin have enacted laws aimed at balance billing, according to a report for the California Healthcare Foundation, of which Lucia is a co-author. However, the protections vary from state to state. Colorado, for instance, requires insurers to protect consumers from balance bills if they received care in a network facility, but from a non-network provider, says Peg Brown, deputy commissioner for consumer affairs in Colorado. In California, ER doctors cannot balance bill HMO members.

How to Protect Yourself
“Ask a lot of questions before you get health care services,” says Jane Cooper, president and chief executive officer of Patient Care, a Milwaukee, Wisc., advocacy firm. Check whether all the health care providers you expect to see are part of your network. Request the information in writing. Although an insurer may balk at taking the time to do this, the request sends the message that you’re trying to be a prudent consumer of health care.

Also, be sure to double check all bills. Many consumers pay up when they do not have to. According to the California Association of Health Plans, a health plan advocacy group, more than 1.76 insured California residents who visited an emergency room in 2006 and 2007 were billed an average of $300 on top of copays and deductibles, or $528 million total.

What if, despite your best efforts, you end up owing money on a balance bill? If your insurance is through your employer, ask for assistance from your human resources department, advises Brown. If paying the bill presents a hardship, talk with your health care providers and try to negotiate a reduction.