Don't Become A Victim Of Balance Billing

December 4th, 2014

What Liberty HealthShare members should do if they find themselves in this predicament.

The Liberty HealthShare payment schedule to medical providers has been shown to be a simple and fair system. However, even after accepting payment for service, some medical providers engage in what is called balance billing.

Frankly speaking, balance billing occurs when a doctor or hospital tries to get extra money directly from a patient after a bill has been paid. This practice isn’t fair, and there is no reason for a patient to pay these bills.

Liberty Healthshare has a payment schedule that every provider in the nation is familiar with. We take the cost of any procedure that is laid out in Medicare and pay an additional fee. We call this Medicare Plus Bonus.

The provider reimbursement terms are clearly explained on the back of every Liberty HealthShare membership card. Payments range from 150% of the Medicare cost for Physicians to 170% of the Medicare cost for outpatient services. We find that 90% of doctors and hospitals approve this without question. If there is an issue with that payment schedule, we will simply negotiate a different one.

Once a provider agrees to the payment schedule, bills are then submitted and paid through our community or directly from the member if that payment applies to their annual unshared amount, from $500 to $1,500 based upon household size.

So what do Liberty Healthshare members do if they are balance billed?

First, if you receive a bill from your provider in the mail, check your online Sharebox. In the Medical Expenses section, you will be able to see any expenses that we have received on your behalf. The bill that you received might be an expense that goes toward your Annual Unshared Amount (AUA). It will be reflected in your online account and will show up under AUA. This is a case in which you are being billed correctly and you will need to pay your provider directly.

However, if it is a bill that is not reflected in your Sharebox, then Liberty Healthshare has not received it, and it might be balance billing. Contact member services immediately. We will work to get this issue resolved. Contact us by calling 855-585-4237.

From there, we will discuss your bill and confirm whether it is an eligible sharing expense, a bill that is in process, or a balance bill. If it is a balance bill, we will turn it over to our provider relations department.

Provider relations will take that bill back to the provider and let them know that they have been paid. If they do not agree with the reimbursement schedule, then we will negotiate a different payment with them.

In the modern age of medical services, unfortunately, balance billing has become a practice in which many providers engage. Many patients are intimidated by it and they may end up paying those bills without contacting Liberty HealthShare. In any case, if you are ever balance billed, know that we are here for you and are ready to support you.