Is Balance Billing Legal in Colorado
1. Emergency Services If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility, the provider or institution may charge you up to the amount of your plan`s network cost-sharing (e.g., co-payment and co-insurance). You cannot be charged for these emergency services. This includes services you may receive after being in stable condition, unless you give your written consent and waive your coverage so that you are not compensated for these destabilizing services. 2. Certain services in a hospital or ambulatory surgical centre on the network If you receive services from a hospital or ambulatory surgical centre on the network, some providers may be outside the network. In these cases, these providers may charge you up to the amount of the shared cost of your plan on the network. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospital doctor or intensive care. These providers cannot charge you and cannot ask you to waive your coverage in order not to be compensated. If you receive other services at these network facilities, off-grid providers will not be able to pay the bill unless you give your written consent and waive your coverage.
You never have to sacrifice your protection against paying the balance. You are also not required to receive care outside the network. You can choose a provider or installation on your plan`s network. If a network is inadequate because no participating provider is available, the insurer must ensure that the insured person receives the covered benefit at a higher cost to the insured person than if the service is obtained from the participating providers. Color. Rev. Stat. § 10-16-704(2)(a). A networked facility is appropriate where there are participating and non-participating providers: an institution offering a managed care plan maintains a sufficient network in terms of the number and type of providers to ensure that all covered services are accessible to insured persons without undue delay. In the case of emergency services, insured persons must have access to health care twenty-four hours a day, seven days a week.
Sufficiency shall be determined in accordance with the requirements of this section and may be determined by reference to any reasonable criterion of the carrier. C.R.S. §10-16-704(1). In addition, in all cases where the carrier does not have participating suppliers to provide a covered service, it will arrange for the carrier to be referred to a provider with the necessary expertise and ensure that the insured person receives the covered service at no greater cost to the insured person than if the service were received by the participating providers. S.C.R. §10-16-704 (2)(a). Where a covered person receives services or treatment in accordance with the provisions of the plan in a network facility, the level of delivery for all covered services and treatments received through the facility is the network service. C.R.S. §10-16-704 (3). Colorado`s personal injury law can be complicated.
If you have been seriously injured by someone else`s negligence or willful conduct, you should contact Gregory A. Hall, Denver`s attorney. If you keep it, Mr. Hall can help you ensure that you are not being billed illegally by your doctor or hospital and that the guilty party is paying you a reasonable amount to compensate you for your personal injuries. Gregory A. Hall Law Office of Gregory A. Hall 3570 E. 12th Avenue, Suite 200 Denver, CO 80206 Tel.
303-320-0584 Email: gregory@federallaw.com Web: www.adenverlawyer.com We can help! The CCHI Consumer Assistance Program can help you resolve credit billing issues. Contact us at help@cohealthinitiative.org. A balance bill or surprise bill will tell you the difference between what your insurance pays the out-of-network provider and what the provider charges for services. If the provider is on the network, you only have to pay for what is negotiated with your health plan – usually a co-payment or percentage of the fees charged. However, if the provider is unexpectedly off-grid, you may be asked for much higher sums. Colorado has limited consumer protection against paying balances. If you receive emergency care or are treated by an out-of-network provider at a hospital or ambulatory surgical centre in the network, you are protected from surprise settlements or balance settlements. If your insurer is unwilling to pay the claim and you believe it should be covered, you have the right to appeal within 180 days of your denied claim. An appeal means asking your insurer to reconsider their decision not to pay.
Keep in mind that if your bill is an actual balance bill, the insurance company may not have been asked to pay and you can send them a copy to do it for you. Call 800-222-4444 and let them know you`ve seen a balance settlement. Colorado`s Surprise Settlement Act, which went into effect in 2020, limits the circumstances in which providers can require you to waive your coverage. One concern about the federal law is that while providers are expected to obtain consent from patients to waive coverage 72 hours before scheduled procedures, patients may still feel ambushed at the last minute and have no choice but to sign up if they want care. Fox said. “In the vast majority of cases, no matter what insurance plan you have, you should be heavily protected from billing,” said Adam Fox, deputy director of the Colorado Consumer Health Initiative. Note: This information should not be construed as legal advice. What do you do if you find an error or think you`ve been charged a balance in error? What is “balance billing” (sometimes called “surprise billing”)? If you see a doctor or health care provider, you may have to pay certain expenses, such as: a co-payment, co-insurance and/or deductible. You may have other costs or have to pay the full bill if you see a provider or visit a health facility that is not part of your health care plan network. “Out of the network” describes providers and facilities that have not signed a contract with your health plan.
Out-of-network providers may charge you the difference between what your plan agreed to and the total amount charged for a service.
