Practice Management

We sometimes see patients' insurance cards that try to impose a restriction on balance billing the patient if the practice accepts assignment on the claim.  "Assignment of Benefits is a waiver of the provider's right to balance bill the patient.  Depositing checks received from the plan represents accord and satisfaction and will take precedence over any previous terms."  The balance billing provisions of the No Surprises Act notwithstanding, are these unilateral terms legal and binding on the practice?

John

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   John E. Pugh

 P: 609.644.4479

 F: 609.503.2476

In my state, yes it is binding. If you cash the check you accept those terms.

Balance billing is illegal under a Mississippi state law passed in 2013. The law states that if a health care provider accepts payment from a health insurance company on behalf of a patient, the provider is prohibited from collecting any amount from the patient above their deductible, co-pay, or co-insurance amount. Mississippi's anti-balance billing doesn't distinguish between types of networks. According to the law, as long as the provider accepts payment from the insurer, "the payment shall be considered payment in full to the provider, who may not bill or collect from the insured any amount above that payment, other than the deductible, coinsurance, copayment or other charges for equipment or services requested by the insured that are non-covered benefits."

One of the largest hospital systems in the state of MS was recently sued by a patient for allegations of doing this exact thing. The case is still in litigation.