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Medical bill States have expanded protections to a wide array of balance billing scenarios and imposed disclosure and transparency obligations on carriers and providers. (Photo: Shutterstock)

Beyond a routine annual check-up and an apple a day in hopes of keeping the doctor away, individuals enrolled in private health benefit plans generally are not keen to see the inside of a hospital or emergency department.

However, when emergency or more extensive treatment is necessary, so long as the patient goes to his health insurance carrier’s in-network providers, and so long as premiums, deductibles and co-insurance are paid, covered persons expect that their carrier will pay for the cost of their medically necessary care. Unfortunately, in many states, even if a covered individual receives treatment in an in-network hospital or emergency department (often for emergent reasons beyond their control), there is often a terrible surprise awaiting them when the bills start to arrive. In many cases after the ordeal, patients learn they were treated by an out-of-network provider when they receive an unexpected “balance bill” from that provider.

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