This article is intended for members enrolled in an individual health insurance plan.
It’s stressful enough to go to the hospital. The last thing you want to see is a huge bill you thought would be covered by your health plan. But surprise bills are common due to “balance billing.”
What Is Balance Billing?
Balance billing can happen when a patient receives care from an out-of-network facility or doctor. That facility or doctor then bills the patient for any amount more than what the health plan allows. Balance billing can cost patients thousands of dollars.
You may have done your homework and chosen a doctor and hospital in your plan’s network, but still get surprise bills. Here’s why:
- Many hospitals use outside doctors to help staff their emergency rooms. These doctors may not be in your plan’s network.
- Even when you planned a procedure with a doctor who is in your plan’s network, you may get a balance bill if an anesthesiologist, radiologist or other doctor involved in the surgery isn’t in the network.
How Can You Avoid Balance Billing?
What can you do to help avoid getting a surprise bill? When you schedule a planned procedure,* ask if all the providers — including anesthesiologists, radiologists and others — are in your plan’s network.
Asking the questions may also help your doctor and others become more aware of the issue.
If you do get a surprise bill in the mail, try these steps before you pay in full:
- Call the care provider who billed you to ask about options to reduce the bill, assistance programs or payment options.
- Call the hospital or other facility where you received care to ask about options to reduce the bill, assistance programs or payment options.
- Call Blue Cross and Blue Shield of New Mexico at the number on the back of your member ID card to ask about your options.
- Check with your state insurance regulator to see if there are protections against balance bills.
Taking these steps may help lead to a smaller bill. In some cases, it may even wipe out the amount due all together. That would be a welcome surprise.
*HMO members must get a referral for most care not provided by their primary care provider (PCP).