I have an article up at healthinsurance.org that assesses (in more detail than the previous post here) the consumer protections against balance billing in the model law recently adopted by the National Association of Insurance Commissioners.
A key question is what happens after a patient forwards a balance bill to her insurer for negotiation or mediation. Can it come back to bite her? There's some precedent in Texas law. Here's the gist:
If adopted as is, how fully will the model act protect a balanced-billed patient who exercises her option to send the bill to her insurer? "If it goes to mediation, the intention is that the patient will be held harmless," say Stephanie Mohl of the American Heart Association, who served as a consumer liaison to the NAIC and advocated for balance billing protections.
The model act does not explicitly guarantee, however, that once the insurer settles the bill with the provider, it won't hold the patient responsible for a portion larger than he would pay for in-network care. The Texas law, upon which this provision is most closely modeled, does not provide such a guarantee, according to Stacey Pogue of the Texas-based Center for Public Policy Priorities.
In practice, however, Pogue says that when patients do initiate mediation, the system seems to be "working really well." Anecdotally, she has heard (mainly from insurers) that the bill is usually resolved with a brief phone call, and insurers usually cover the whole.
