Well I guess California is not the only state to enjoy this wonderful area of question here and its worth a look by all means as contracts and custom and standard rates do vary. Sometimes the policy is not always clear on what is covered and what is not, plus additional items could be added in the course of caring for a patient too.
We had balance billing big time in California based on out of network hospitals seeing patients in cases of emergencies, etc. and it’s all about those cost savings algorithms and contract between all. Noted in the article is the fact that some of the balance dues were out of network and I don’t know how far back the allegations go but if they go back further than let’s say the last couple of years, then they may have a big case on the out of network charges as almost all carries used the low ball “Ingenix” data base from United and there are lawsuits all over the country for those bills, and it took a while for carriers to quit using it as even Health Net in California less than 2 years ago finally quit using the data base to assess normal and customary fees out of network in California and prior to that paid claims at17% higher than what was given on the query. BD
Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana
A local factory worker has sued Washington University in St. Louis, accusing the university's doctors and other Missouri health care providers of routinely and illegally over-billing for medical services.
The suit, which seeks class-action status, was filed Friday in the Circuit Court of the city of St. Louis. It asks for actual and punitive damages based on allegations that thousands of insured patients have sustained financial losses and damages as a result of such billing practices.
Specifically, the suit contends that "balance billing," which most state health care providers use, violates the Missouri Merchandising Practices Act, which deals with consumer fraud and forbids deceptive and unfair practices.
He said the practice also called into question whether insurance companies were paying fair rates to providers. "My health insurance carrier has agreed with me to pay health care providers a fair and reasonable amount for the services provided," he said. "If my health insurance carrier has provided payment in a fair and reasonable amount, why would a health care provider ever be entitled to more than that?"
Greg Thompson, a spokesman for United HealthGroup Inc. in Chicago, said that billing practices varied because some patients had out-of-network benefits and others did not.
Lawsuit challenges Wash U medical billing practices
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