How To Fight Balance Billing in Nevada

Balance billing, also known as “surprise billing,” is a situation where a medical provider takes the amount a medical provider charges, subtracts the allowed amount, and then takes that remaining amount and bills it to the patient.

Medical offices tend to use the balance billing approach when an insurance company pays less than what the provider actually charges for care. The problem with this approach is that it often results in patients paying more than in-network costs for a specific service and, worse yet, that overage doesn’t generally count toward their deductible or out-of-pocket obligation.

Our state has laws in place prohibiting balance billing to what it refers to as “covered persons,” but only in certain situations, according to the Nevada Division of Insurance. Below, we’ll share how to fight balance billing in Nevada.

Determining if You’ve Received an Accurate Bill

Many medical providers’ bills that get sent out may not reflect the correct services a patient received, or insurance payments are applied incorrectly, and patients receive bills for balances they don’t owe.

Billing errors, unfortunately, do happen, and bills get sent out that shouldn’t, or that contain inaccurate information. Here are steps to take to determine if you received an accurate bill:

• Verifying that it’s indeed for you or your relative
• Looking at the itemization list to see if you were billed for services actually received
• Determining whether the services received were covered by your insurance policy (i.e., a mammogram for women over a set age) or not (i.e., a cosmetic procedure like liposuction)
• Ascertaining whether the provider that you received the bill from was your primary in-network caregiver (i.e., a surgeon you directly were working with) or one you were indirectly dealing with (that was perhaps out-of-network) like an anesthesiologist

In terms of the points mentioned above, you must understand a few key pieces of information, including:

• You have a right to request an itemized bill if a medical office doesn’t send you one before rendering payment
• The application of Nevada laws prohibiting balance billing in certain instances may apply to both in-network hospitals and out-of-network medical providers, depending on the circumstances, or at least require the facility or practitioner to disclose their out-of-network status before remitting such a bill

Steps To Take if You Received a Balance Bill

So, you’ve inspected the bill and deemed it to indeed be your own and verified that it was for services rendered, but you have a hunch that the insurance payment should have wholly covered the cost without any patient obligation being due, the best course of action would be to contact your insurer or provider’s billing company.

Speaking With Your Health Insurer

The reason you might want to speak with your health insurance company is to inquire why they didn’t pay the complete amount and see if they might be able to work out something with your provider so you don’t have to pay the difference.

Contacting Your Medical Provider

If you speak with your provider’s biller, you may want to discuss lowering the charges billed or simply the prospect of them accepting the in-network payment they already received and taking the remainder as a write-off. You may also want to broach the topic of setting up a payment plan.

Reconnecting With Your Health Insurance Company

Should none of these approaches work, you may want to circle back and speak with your insurer about what their appeals process is and pursue that.

Reaching Out to the Nevada Division of Insurance

If you have reason to believe you were billed incorrectly and resolving the matter independently with your insurer or medical provider didn’t prove successful, you may want to consider contacting the Nevada Division of Insurance at 1-888-872-3234.

Alternatively, you can submit an online complaint to the state office.

Contacting an Attorney About Pursuing Litigation

Litigation may be an option if you’ve deemed the bill to be inaccurate, your patient obligation is particularly high, and none of the other steps outlined above have proven successful.

Of course, it’s best to have an attorney involved anytime litigation is in the cards. So, if you’ve tried to settle matters amicably with your medical provider or insurance company and nothing has come of it, and taking the case to trial seems necessary, certainly contact a lawyer who handles disputes with health insurers to help you navigate the legal system.

How Bad Faith Insurance Lawyers Defend Clients

Lawyers are trained to interpret legal contracts, like the health plan subscriber agreement, and know the state statutes that apply to certain types of cases. They can apply that insight to your balance bill situation to determine whether you’ve been subjected to bad faith insurance practices and, if so, what rights Nevada law affords you.

If you decide to hire an attorney like ours at the Law Office of Matthew L. Sharp to represent you in your medical billing matter, you expect us to advocate aggressively for you. We do so to secure the benefits, interest, and other damages you may be entitled to in your case.

So, if you want reliable information about whether a medical provider’s billing practices are appropriate in your situation and you want to seek justice, contact our law firm as soon as possible.