How Insurance Providers Are Stiffing Their Policy Holders

How Insurance Providers Are Stiffing Their Policy Holders

Industry Talks

Now more than ever, network benefits and health care rights are being hotly debated. As a policy holder in Texas, you’re entitled to emergency care at an in-network rate. This applies no matter if the facility is in-network or not, but insurance companies are creating loopholes to avoid compensating physicians.

Learn what steps are being taken to help stop this injustice and what you can do to end the insurance gap.


So how do insurance companies work around this state requirement?

While a hospital may be in-network with your plan, a particular physician may not, even if you’ve been seeing them for years. This means that you’ll receive a bill saddling you with whatever your insurance carrier refuses to pay, increasing their profit margins and creating the insurance pay gap.

What steps can be taken to combat predatory insurance providers?

We encourage our customers, and all policy holders, to research their healthcare rights. Education is a crucial step in ensuring that predatory insurance providers can’t take advantage of you. To see estimated costs of emergency care, visit this link.

You can also call your state representative and voice your concern over the insurance pay gap. Not sure who’s your representative? We’ve got you covered.

We want legislation passed in every state that protects policy holders from these loopholes. When speaking with your representative, make sure to bring up these points.

  • Transparent and predictable pricing for medical services so patients are never surprised about what is – and what isn’t– covered.
  • An adequate number of physicians in a health plan network so patients aren’t forced to receive care from an out-of- network physician.
  • An appropriate and fair standard is created for out-of-network services that establish a charge-based reimbursement schedule (meaning 80th percentile) connected to an independently recognized and verified database.
  • In-network out-of-pocket costs for unexpected out-of-network care so patients aren’t hit with surprise bills down the road.
  • Comprehensive protections so patients are removed from payment disputes.
  • A clear mediation process so patients or physicians can initiate action.
  • Strong penalties for insurance companies and physicians that violate this law so patients are always protected. *

‘Industry Talks’ is any blog posted that directly affects our customers. We aim to be as transparent as possible in our billing process and keeping our customer base informed about possible changes in their insurance coverage is a crucial part of that mission. 

Visit here for more information about the end the insurance pay gap campaign or to share your story.

*Source: http://endtheinsurancegap.org/what-is-the-surprise-insurance-gap/

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June 27, 2016

Jennifer Anderson

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