Dr. Joaquin Lopez ‘s surprise emergency room bill came after he and his insurer had already paid $11,000 toward the cost of emergency gallbladder surgery. For dentist Brad Buckingham, who fell off his bicycle, the shock was a $70,000 bill to repair a broken hip. For Stacey Shapiro, it was a $6,720 emergency room fee to treat sudden spell of low blood sugar.
Balance Billing is at the Heart of the ER charge lawsuits. Balance billing refers to a physician’s ability to charge the patient any outstanding balance after an insurance company submits its portion of the bill. Out-of-network physicians, not bound by contractual, in-network rate agreements, may bill patients for the entire remaining balance.