Balance Billing: Class Action Lawsuit Investigation

Last Updated on June 26, 2017

Investigation Complete

Attorneys working with ClassAction.org have finished their investigation into this matter.

Check back for any potential updates. The information on this page is for reference only.

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At A Glance

This Alert Affects
Anyone who's received a surprise medical bill after receiving care they believed was covered.
What's Going On?
Patients across the country are complaining that after going to in-network providers, they received bills from emergency room doctors, anesthesiologists or other healthcare providers they didn't know were out-of-network. This practice is known as balance billing.

Case Update

Important Information

Thank you to everyone who contacted us regarding this investigation. Lawyers working with ClassAction.org have spoken to dozens of patients and looked at the contracts their employers had with their health insurance carriers. Unfortunately, after their investigation, they decided not to proceed any further with the matter.

That being said, although we no longer need to speak to people who have been balance billed, anyone who thinks they have a case is strongly encouraged to find a local attorney they can speak to about their rights. It's important to keep in mind that there are time limits for filing lawsuits.

You can view our current list of lawsuits and investigations here.

What Is Balance Billing?

Balance billing occurs when a patient goes to an in-network provider, such as a hospital, but gets a bill from an anesthesiologist, emergency room doctor or other healthcare provider they did not know was out-of-network. The bill states that the patient is responsible for the difference between what the provider charged and what the insurance company covered for the out-of-network care – hence the term “balance billing.”

Examples of Balance Billing – In-Network Doctor, Out-of-Network Hospital

Most people assume that if they receive care at a hospital, doctor’s office or out-patient facility that is in their network, all care received under that roof will be covered. Unfortunately, this is not always the case.

Below are some examples of instances in which a patient goes to an in-network facility, but is still charged for out-of-network services.

Anesthesiologists

A patient receives a colonoscopy at an out-patient facility that is covered by his insurance. The doctor who performs the procedure is also in-network; however, a month later, the patient receives a bill for the anesthesiologist who sedated him. The health insurance company claims that even though the facility was in-network, the anesthesiologist who worked there was not and that the patient is responsible for the balance on the bill.

Emergency Care

Another common example of balance billing occurs when someone is rushed to the hospital in an emergency. Even if the patient can get to a nearby, in-network hospital, he or she can still receive bills for out-of-network services.

For instance, assume a man visits the emergency room after experiencing symptoms of a heart attack. The patient sees the emergency room doctor and is released. He then receives a bill for the doctor’s services.

Even though the man made the effort to visit an in-network hospital, he was still charged for out-of-network care. This is because most doctors, including surgeons, are not hospital employees – which means that they’re not members of the same insurance network as the hospital.

Other Examples

  • A patient goes to his doctor to have blood drawn or to have a biopsy taken and the sample is sent to an out-of-network lab
  • A patient receives an x-ray or CT scan at an in-network hospital but the film is sent to an out-of-network radiologist
  • A baby is born prematurely at an in-network hospital and is treated by an out-of-network neonatologist

Is Balance Billing Legal?

Balance billing, while unfair, has generally been accepted as legal in most states, with a few exceptions. Attorneys working with ClassAction.org, however, have uncovered new information that could make class action lawsuits against health insurance companies an option for patients who were forced to pay the balance after receiving care out-of-network.

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