Assemblyman vows action over medical billing procedure

Friday, July 14, 2000 | 11:25 a.m.

A state assemblyman dismayed by a medical bill that he believes he should not have to pay said he will take legislative action to stop a practice known as balance billing.

Assemblyman Doug Bache, D-Las Vegas, a math teacher at Charles I. West Middle School, said that when a family member needed treatment through University Medical Center he made the co-payment through his Clark County Education Association health plan.

Bache assumed his co-pay would cover the medical service through the contract UMC has with his health plan. But he still wound up last month with a bill from UMC for $68.75 along with the statement, "your insurance has paid. The balance is your responsibility."

"This is the first time I've been aware of the problem," Bache said. "But there may have been a couple other bills that I paid that maybe I didn't have to pay. I was puzzled more than anything and a little angry that they're trying to collect a little extra money over the amount our health plan should be charged.

"I don't know if it is intentional or just bad management."

Bache complained to his health plan and his dispute is pending. UMC spokeswoman Trish Lampro said she could not discuss the bill sent to Bache because of patient confidentiality.

"In general the hospital makes every effort not to send out bills to patients covered by insurance," Lampro said. "In most cases the information should be sent to the insurance company."

The Sun reported last month that the practice of balance billing is becoming more commonplace. Under balance billing a patient receives bills listing the full amount of a medical service even though he made his co-pay.

Such bills typically show the retail rate of the medical service provided, which is more than the discounted rate physicians and clinics agree to charge health plans under their contracts. The bill may show that the patient owes either the full amount or the difference between the retail rate and the discount rate.

Physicians and clinics say they do this when they believe the health care plans have been delinquent with their reimbursements. Balance billing, they say, is simply a way to prod the patient to contact his health plan to pay the contracted rate.

That is because the patient really does not owe any money. But medical providers say the patient is fully responsible to pay a bill if the health plan does not make any reimbursement.

A new state law effective last year gives health care plans only 30 days to approve or deny an insurance claim and up to 30 additional days to reimburse the medical provider if the claim is approved.

But Bache said that if re-elected this fall, he plans to introduce legislation next year to penalize medical providers for excessive balance billing.

"If it's a habitual problem and it's not corrected, maybe we need legislation where they pay three times the amount of the bill to the patient," Bache said. "The reason for that is to change their behavior. I believe that with that penalty they would correct that practice so that it doesn't happen again."

Such a bill likely would be introduced to the Assembly and Senate commerce committees.

"There would be an excellent chance of passage," Bache said. "But we would have to craft it so that we're not unduly burdening the businesses."