“We all know that the average American health care consumer seldom have the money to pay their own health insurance deductibles and co-insurance, especially now that health plans are gravitating to higher deductibles and out-of-pocket exposure. Paying these expenses is difficult enough, much less balance bills” – Molly Mulebriar
Balance billing may occur when an insured seeks medical treatment out-of-network. Under Cost Plus / Reference Based Pricing models almost all claims are out-of-network. Instead of paying a PPO network to access secretive contracts requiring plan sponsors to pay as much as 180-500% of Medicare or more, some employers are leaving managed care networks. These employers are paying 100-150% of Medicare in the belief this method is fair, reasonable and defensible. They are prepared to address and defend balance billing issues as they arise.
Hospitals are fully aware that most American cannot pay enormous balance bills, yet a few attempt to seek payment anyway. The strategy is not about collecting the money from employees, it is about causing enough pain for employees that anger and dissatisfaction directed towards the employer creates enough pressure to cause the company to pay and, ultimately, to abandon a reference based health plan.