As some of you in our space may be aware we have recently noticed Tenent is aggressively going after RBP accounts across the country seeking the difference between billed charges and plan allowable despite accepting RBP patients, taking an Assignment of Benefits, and cashing benefit checks.
Legal experts opine Plan Sponsors are not liable – plans pay exactly what is stipulated in the Plan Document – nothing more and nothing less.
They suggest members owe no more than their deductible and coinsurance as is memorialized in a contract between the provider and member (called an Assignment of Benefits).
It would appear to some that Tenent is simply trying to extort monies from plan sponsors (they know Joe Sixpack doesn’t have a spare $75,000 – he struggles hard enough just to pay his deductible these days)
We received yet another email this morning referencing Tenet’s latest bite at the apple in which the writer wrote in part:
“…….a very unpleasant surprise has provider lawyers writing letters to the plan or to members asking for payment on RBP balance bills dating back to dates of service in 2019 or even 2018. 2 such letters even arrived this month…… We were wondering if (Name Redacted) has access to any templated responses we could give them to respond to what we believe are frivolous attempts at collecting money from the plan or members”
I suspect some plans will begin to exclude any benefit coverage at Tenent facilities going forward.
As Tenent’s legal tentacles spread and more plans affected there will be some hotshot reporter like Alan Marshall exposing “The Bite.” That kind of exposure will ensure plan sponsors winning public opinion support and fuel the continuing interest in balance billing legislation.
