LewisGale ER patients cite billing problems after seeing out-of-network physicians

Salem, Va.-based LewisGale Regional Health System emergency room physicians are out of network with Anthem, which has created billing problems for patients, according to The Roanoke Times.

The issue reportedly stems from LewisGale's contract with Schumacher Clinical Partners to provide ER physicians.

Since Schumacher physicians are not in Anthem's network, they are not bound by an in-network rate agreement and are allowed to balance bill members.

Balance billing occurs when privately insured patients receive services from an out-of-network provider and are billed for the balance after the insurance company pays its portion. Patients who receive a balance bill are often on the hook for massive out-of-pocket costs.

Schumacher said it would not balance bill Anthem members, but some patients said they were directed to pay the entire bill for ER physician services, according to the Times.

LewisGale referred questions about billing from the Times to Schumacher and Anthem.

Schumacher spokesperson Maura Nelson maintained that the company is not balance billing LewisGale ER patients and told the Times it has created an email  for Anthem patients with unresolved billing issues: pcc@embcc.com.

 

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