By Ralph Weber
Early in May 2014, the administration released guidelines http://www.dol.gov/ebsa/faqs/faq-aca19.html that stated that balanced billing which exceeds the reference price is not subject to the employee out of pocket limit of $6,350 for single people and $12,700 for those with dependents. This means that if your plan sets the reference price for a procedure at $5,000, and the provider bills $25,000, the insured may have to cover the additional $20,000 out of their own pocket, in addition to any plan deductibles, co-pays, and co-insurance.
