On 07/01/2016, new legislation will be in effect that prohibits out-of-network provders from balance billing members for covered services. This is for the PPO and EPO plans. It states that if the services provided are covered emergency services, OON providers may only bill insureds for applicable cost sharing expenses, example: Copays, deductibles and coinsurance. So who decides the allowed amount if there is no contract? What if our bill is $1000.00 and the insurance company is only going to allow $800.00, do we have to write of the $200?
Can anyone shed some light on this subject? Thanks in advance.