What is a Balance Bill?
Individuals using traditional insurance often unexpectedly receive “balance bills” from their medical providers in the mail, charging them for services that they thought their insurance would cover. Balance bills are issued when a patient receives medical care, and the provider decides to charge the patient the difference between the amount they originally charged for the service and the amount paid by the patient’s insurance plan.
This practice, also commonly called “surprise billing”, is not the same as charging a deductible, co-insurance, or a co-pay. It often occurs when a doctor’s office changes their insurance network or when a patient accidentally visits an out-of-network provider.
Balance billing commonly affects those using traditional insurance but can also occur for people who rely on healthcare sharing ministries for their healthcare. Balance bills are a major issue with the healthcare industry in our country, but Solidarity addresses them by advocating for our Members to defend fair and just pricing when a balance bill occurs.
Does Solidarity Dispute Balance Bills?
Yes, Solidarity will help Members dispute balance bills, so long as the health care services provided are within our Sharing Guidelines. This Patient Advocacy service is beneficial to families who lack the time and expertise to negotiate bills themselves.
Providers will occasionally issue balance bills when they see that the amount shared by Solidarity Members is less than what the provider originally requested in payment, and don’t understand the way our Reference Based Pricing model works. So, they attempt to charge the Member the difference.
If you receive a balance bill, you should NOT:
- Pay the bill
- Ignore the bill
- Contact your doctor
Instead, you should call our Patient Advocacy team at 855-201-1508 right away so that a Patient Advocate can guide you through the next steps to dispute the balance bill. It is worth bringing balance bills to Solidarity’s attention because many times health care providers waive the outstanding amount altogether after hearing from one of our Advocates.
Limitations to Disputing Balance Bills
Timing restrictions can pose a limitation to successful bill disputes. However, if you are aware of all relevant dates and deadlines, disputing balance bills is seamless and straightforward. Please reach out to Solidarity immediately to begin the dispute process, and keep the following deadlines and limitations in mind:
- Members have 60 days to dispute a billing error under the Fair Credit Billing Act (FCBA)
- The 60 days begins on the date of the first account statement that includes the potential billing error, not the date of service
- It can take up to 12-18 months, or longer in rare cases, to resolve a balance bill since providers typically bill on 30-day cycles and auto generate their bills
- Members might receive a duplicate or additional balance bill while the provider is processing the dispute
Will Balance Bills Affect My Credit Score?
Solidarity tries to ensure that disputed bills will not affect our Members’ credit scores. In fact, our Patient Advocacy team will send Fair Debt Collection Practices Act (FDCPA) dispute letters to collection agencies and to all three credit bureaus on your behalf if a provider has improperly sent a bill to collections. This is why it is so important to notify that team promptly after receiving your balance bill, and to continue sending them any additional bills that you receive. That allows them to continue to actively dispute the balance bill for as long as it takes to be resolved.
Additionally, pursuant to a joint announcement by Experian, Equifax, and TransUnion, unpaid medical debt will not affect an individual’s credit score until it has been unpaid for more than a year and is more than $500. This change took effect July 1, 2022.
Solidarity Disputes Bills to Keep Costs Low
Finally, remember that balance bills arise on only about 4 percent of the medical needs our community shares. But when they do, Solidarity is committed to advocating on behalf of our Members to keep medical costs low.
As a faith-based healthcare sharing ministry, part of our mission is to help our Members achieve the best possible medical attention for the most reasonable cost. Defending our fair and reasonable pricing is a huge part of why we are able to help Members keep their healthcare costs down, while also making sure that our Members’ medical needs are met.
Visit the Solidarity HealthShare FAQ page today to learn more about how Solidarity can help your family achieve quality health care at a reasonable cost!