Tennessee lawmakers target balance billing: 3 things to know

Farm Bureau Health Plans and state Rep. Ron Travis (R-Dayton) are working together on legislation aimed at curbing balance billing, according to a report from The Tennessean.

The practice of balance billing refers to an out-of-network physician's ability to bill the patient for an outstanding balance after the insurance company submits its portion of the bill. Balance billing may occur when a patient receives a bill for an episode of care previously believed to be in-network and therefore covered by the insurance company, or when an insurance company contributes less money for a medical service than a patient expected.

Here are three things to know about the proposal in Tennessee.

1. The proposed legislation would require hospitals or the physician to notify the patient ahead of a scheduled procedure that a provider is out-of-network or accept the in-network negotiated rate, according to the report. They would also have to provide a reasonable cost estimate.

2. Benjamin Sanders, executive director of government affairs for Farm Bureau Health Plans, told The Tennessean the insurer wants to increase transparency because "increasingly our members tell us that this is a problem."

3. The Tennessee Medical Association has said it wants a proposal that doesn't place the responsibility on the provider, who may not be able to immediately access the patient's insurance details, according to the report.

 

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