Clinical Laboratories, Pathology Groups Being Squeezed by ‘Balanced Billing’ Dispute That Puts Providers, Hospitals, and Insurers at Odds

Health plans increasingly refuse to pay out-of-network providers who they claim often inflate their charges, leaving patients with unexpected medical bills 

As health insurers narrow their provider networks in an effort to lower costs and hold down premiums, clinical laboratories and anatomic pathology groups may increasingly be designated as out-of-network providers and find themselves struggling to get paid.

This is particularly true in cases where a hospital is in-network and its hospital-based physicians—including its pathologists—are out-of-network for that same insurer. Following their discharge from the hospital and their insurer’s payment of the hospital bills, patients are surprised to get bills from the hospital-based physicians.

It is a problem that won’t go away soon. That’s because it is increasingly common for patients who are being treated in an in-network hospital to unknowingly receive care from out-of-network doctors, such as pathologists, anesthesiologists, emergency physicians, hospitalists and radiologists, who may not participate in the same plan networks as the hospital does. (more…)