Balance billing strikes again

A couple of articles about balance billing came out last week, including this one published on Slate. The practice refers to how out-of-network physicians are generally entitled to bill patients when their insurance plan does not cover the full amount owed. Years ago, the general sentiment would have been that patients should have been more careful to stay within their plans' network. Over the last few years, however, a number of articles have come out detailing how patients have indeed been checking that their providers are in-network, but being surprised by balance billing when out-of-network providers get involved. For example, if a surgeon encounters a complication and would like to get a consultation or some assistance from an out-of-network provider, who should pay?

When patients check ahead of time that both the facilities that they are visiting and their providers are both in-network, balance billing is a symptom of a much bigger debate between payers and providers where patients tend to be collateral damage. Payers feel that providers are asking for too much and might not sign on some providers, and providers feel that payers pay too little and don't accept certain plans. Instead of an upfront resolution, the patient is caught in the crossfire. From the patient perspective, the key question seems to revolve around whether a facility should be able to call itself in-network if patients being treated there might be exposed to out-of-network charges. When patients have done the due diligence of figuring out whether both the facility and the provider are in-network, what more can be reasonably expected of them?