Balance Billing: The Implications for Healthcare Executives of Current Legislation, Policy and Regulation

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Presented By

Robin Gelburd, JD

President
FAIR Health
About the Session

The roiling national debate about balance billing for out-of-network healthcare services continues. In this program, we will examine the current laws, policies and regulations concerning balance billing that may affect healthcare executives in their areas of operation. We will present data showing the implications of different models for resolving the issue of how providers should be compensated for out-of-network care. Armed with this knowledge, executives can plan strategic responses. Balance billing may occur when consumers receive out-of-network emergency services or unexpectedly receive “surprise” services from an out-of-network provider. Consumers may be billed for the full amount or for the balance of the bill uncovered by insurance. The debts incurred can be substantial, detrimentally affecting patients’ pocketbooks and credit ratings and sometimes leading to bankruptcy.

Learning Objectives:

  • Discuss federal and state approaches to balance billing and the implications of the different models for resolving the issue of how providers should be compensated.
  • Assess how current laws, policies and regulations concerning balance billing may affect healthcare executives and how they can use this knowledge for strategic planning.

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