We have all heard of “Wild Bill”, Bill Bradley, Bill Bailey, Bill Clinton (a personal favorite), and the always popular “I didn’t receive a bill.” But there lingers in the health insurance community, a nemesis known to us all. It goes by the name of “Balance Bill” Balance Bill does not work as a trapeze artist nor is he an expert in equilibrium or vertigo. “Balance Bill” is an exercise carried out by providers in the form of doctors, hospitals and ancillary facilities when they want more money then they received from the carriers they submitted to and certainly when they want more money than they deserve.

“Balance Bill” preys upon unwitting insureds and sadly, some brokers who don’t realize that balance billing on an in-network basis is wrong in most cases.

Try receiving help from the carriers on this problem and you a referred to “OUR PROVIDER RELATIONS DEPARTMENT”, no doubt a nomadic group of employees who roam the halls of their respective home offices looking for someone to tell them exactly what is it they’re supposed to do. Who are these people????

Try calling the doctors office to educate them on this ungodly practice and you are put on the phone with the office manager. Let’s pause for a moment here and ask the questions, “Why does every office manager in every doctor’s office in New Jersey think they know more about health insurance than we do? Why do they all sound like Selma Diamond? Why do they talk to us with the personality and disposition of a Nurse Wratchett? Why, maybe they are evil, evil people looking to line the doctor’s pocket with more cash!

Ever try calling the billing department of a major New Jersey or New York hospital? You get to hear things like, “The carrier never paid us”, the carrier paid us and then took back the money, “the anesthesiologist just bought a new BMW and needed more money for the moon roof”, “we had a computer glitch again” and on and on and on. By the time you get off the phone your thinking, “I should have listened to my mother and become a chiropodist.”

“Balance Billing” is unfair to those who use their insurance correctly, pay their co-pays and expect the carriers to pay the rest of the allowable amount due to the provider. We need to have a system in place to protect against this blatant attempt to extract more money from our pockets. We must implore the carriers to gear up their provider relations departments. They need to GO OUT AND VISIT THE DOCTOR’S OFFICE and properly instruct them. We need to advise our clients to call us if they receive bills which they thought were already taken care of.

Lets eliminate “balance billing” from the hearts and minds of those office managers forever. Why should they care anyway, they drive Pontiac Sunbirds!

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