Under SMI, beneficiaries are responsible for paying the difference (balance billing
) between the physician's submitted charge and the Medicare-allowed charge on unassigned physician and supplier claims.
The average balance billing
liability per user, however, was about one-third higher for disabled beneficiaries ($202) than for aged beneficiaries ($153).
Canadian physicians seem increasingly unhappy about their dwindling professional autonomy.(17) In 1987, a strike by Ontario physicians protested their lack of financial autonomy (in that case, the ban on balance billing
* Beneficiary balance billing
liability (the difference between the physician's submitted charge and the charge allowed by Medicare on unassigned claims) decreased from $2.7 billion in 1984 to $1.9 billion in 1988, reflecting the impact of DEFRA 1984, especially MPP incentives to encourage physicians to accept assignment of Medicare claims.
Estimated total incurred potential liabilities for physician and other noninstitutional suppliers of services, including balance billing
amounts, were approximately $35.5 billion in 1988, about 8.9 percent above 1987.
To protect Medicare participants, Congress adopted limits, Balance Billing
Caps (BBC), on the maximum amount a provider can balance bill.
PPACA itself "does not require plans or issuers to cover balance billed amounts, nor does it prohibit balance billing
," the agencies say.
"Under the program, it is 'no balance billing
' for all its members [so] that means everything will be taken care of by PhilHealth and patients will not be billed beyond what PhilHealth is required to pay by law," Ona explained.
However, some critical observers of the Washington scene note that the Medicare volume performance standards contained in the final bill and the eventual restriction on balance billing
to 115 percent of an approved national fee schedule have the potential to achieve the same ends as the unwelcome ethods, only carrying a different label.
Health insurance agents and brokers have been trying to get someone out there to do something about the balance billing
problem for years.
(PhilHealth) for violation of the so-called "no balance billing
" system, its president said on Tuesday.