Given the recent upheavals in the medical insurance industry, a growing number of consumers are forced to negotiate their own medical bills. This can be a daunting prospect because most of us are not involved with the high-level price negotiations that take place between large medical corporations and the public and private insurance entities. Further complicating a consumer’s ability to understand the costs of their own healthcare are:
· the common practice of forcing consumers to sign a waiver in which they also agree to pay whatever is charged for a service regardless of whether their insurance fully covers that service;
· the practice of obtaining a patient’s consent without disclosing the price charged for a procedure or test, or the opportunity to consult with the patient’s medical insurer; and
· the complexity of medical bills which are often filled with words, acronyms and codes with which most of us are unfamiliar.
If you are being asked to pay a portion of your medical bills not covered by insurance and you live in Illinois you may have some recourse. At The Ratowitz Law Group we are here to help. I urge you to read on and, if you feel this may describe your situation contact me for a free consultation and we’ll analyze your situation together.
Many large healthcare providers negotiate special pricing contracts with insurance companies. These are often called Facility Participation Agreements [FPA’s], although they go by many other names. In these agreements, the provider and insurer agree on specific prices for specific services. Many of these contracts require the provider agree not to charge the insured individual above and beyond the price agreed upon in the contract. In other words: if the provider charges $400 for a test, but the FPA specifies the insurer will pay $300 for that test, the provider agrees they will not charge the insured individual the remaining $100. In many cases, however, the medical provider accepts the $300 from the insurance company and then sends a bill to the patient for that remaining $100.
If you have had medical treatment and your insurance paid for a portion of that treatment but your provider is demanding that you pay the rest, you should ask if they have an FPA or any other type of agreement with your insurer that covers pricing. Ask to see that agreement – or better yet, bring that agreement to me: I’m happy to read it for you. Together we can determine whether or not you’ve been overcharged and then discuss the best course of action to take.
Contact me by email at David@RatowitzLawGroup.com or call 312 577-9405.