If my explanation of benefits from my health insurance states do not balance bill patient, do I have to pay.?

Question

Many of the EOB's state do not balance bill patient and/or Beech Street Provider Discount. Yet, I am still being sent a bill for the remaining amounts.

Do I need to pay these if it states do not balnce bil patient?

Answer 1

Great question, I'm dealing with the EXACT same thing myself.

Here's the issue - the "do not bill patient" is a contractual agreement between the insurance company and the provider, but good luck getting a copy of the contract.  If the provider sues you, you'll have to convince a judge that you shouldn't have been billed, and you can't bring the insurance company in, as they aren't party to the transaction between YOU and the PROVIDER.  

Bottom line - for me, I'm going to let the provider try to sue me for it.  Then I'll bring the EOB to court.  I'm pretty sure the provider WILL try to sue me for it.  They sure haven't seen reason yet.

Answer 2

hi, i work for an insurance company and see this often.. what you need to do is get in contact with the provider relations department of your insurance company to advise them that the provider is balance billing you. they should step in and help out, as this is a contractual issue. im not really sure what the other person is talking about here, but of course they arent going to give you a copy of their contract, as its confidential (why would you need it??).. anyhow.. just let the insurance know. the provider would be stupid to take you to court, as they have signed a legally binding contract against doing these sorts of things. why would they take you to court to show their ****es? haha. you will be fine my dear. dont pay them anything higher than what your EOB states, and keep all your paperwork.

Answer 3

Have you contacted the provider and explained that the balance is their contratual write-off?

Or contact your insurance and let them know. The doctor is violating his agreement with them for billing this amount to you.