HHS Secretary Backs Medicare Balance Billing


Generally speaking, patients really dislike balance billing.  Sometimes called “surprise billing,” “balance billing” refers to billing a patient for the difference between the health care provider’s charge and the amount a patient’s insurance company pays.  Say, for example, the doctor charges $125 for a procedure and the insurer pays only $100.  Balance billing occurs when the doctor sends the patient a bill for missing $25.

While most patients don’t favor balance billing, some powerful people do.  One of them is the new Health & Human Services Secretary Tom Price, and he’s in charge of the biggest insurers of them all: Medicare and Medicaid.  He backs legislation that would repeal Medicare’s long-standing prohibition against balance billing of Medicare patients.

A retired orthopedic surgeon, Secretary Price has never made it a secret that he favors balance billing.  While serving in the U.S. House of Representatives, he introduced legislation to allow balance billing several times.  None of the bills got very far.

Price’s rationale is that balance billing would help persuade more physicians to accept Medicare patients—physicians who currently don’t accept Medicare patients because the payment rates are too low.  Attracting more physicians would help address the physician shortage that currently  limits access by the elderly to health care.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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