Why did I receive a balance bill?
Balance bills are, unfortunately, common in the U.S. healthcare industry, no matter what medical insurance you have. In fact, they can happen to insured and uninsured patients alike. Fortunately, Sana uses Reference Based Pricing (RBP) to determine the amount we pay providers for specific services. Since our payment rates are based on the fair current market rate, providers typically accept it. But on occasion, providers will choose not to accept our pricing and will send you the bill directly. This is called a balance bill.
Do I have to pay my balance bill?
No, but you do need to take action asap by paying the patient responsibility outlined in your Explanation of Benefits (EOB) and sending Sana the bill with proof of payment.
Sana and our partners work hard to try to make sure our members never have to pay balance bills. To date, we’ve successfully resolved 100% of known balance bills without a single member owing more than their plan's patient responsibility.
Why do I have to pay my patient responsibility before Sana can resolve the balance bill?
If you have not paid your patient responsibility, a bill is not considered a balance bill.
Balance bill negotiations can only start once providers have received payment in full per your Explanation of Benefits (EOB).
Will a balance bill affect my credit score?
There is a <1% chance that a balance bill will affect your credit score, provided you report it to Sana when you receive it. We assign your case to our negotiation partner, Zelis, formerly known as Payer Compass, who takes precautions to avoid any impacts to your credit scores across all three bureaus. Their negotiation process is tailored to ensure a settlement occurs within 180 days (the waiting period before a medical debt reported by a collection agency may appear on someone’s credit report) of your account being referred to collections and we work with credit agencies to ensure they are aware any such charges are being disputed. In addition, we work with our claims negotiations partner, The Phia Group, who provides an extra level of protection by giving you outside counsel representation if needed to support more difficult and escalated balance bill cases in the rare instances when they occur.
What should I do if I receive a balance bill?
Please email it to us at firstname.lastname@example.org. We'll review the bill and send it over to our negotiation partner, Zelis, who'll reach out to your provider to negotiate the balance. Zelis will be in touch with you from that point on to make sure you know the status of your balance bill.
What do I do if my provider keeps contacting me to pay the total amount of the balance bill?
You should never feel the need to engage with a provider harassing you for payment unless they start withholding care, and in that case you should reach out to Sana for help. Do not agree to a payment plan or to pay any portion of this bill. If you do, Sana and our partners will lose our leverage and our ability to resolve the balance bill on your behalf.
At times, it might feel like it would just be easier to pay the bill, but please remember balance bills are a big part of what’s causing healthcare to be so expensive and it’s important that we stay strong and demand fair prices. We know it can be hard to wait for the process to run its course. Remember it’s not appropriate for the provider to be charging you more than your patient responsibility in the first place.
Providers and facilities will occasionally use scare tactics to try to get you to pay more than you owe according to your plan, and they often drag out balance bills because they know this makes patients anxious and more likely to pay the full amount they’re asking. We ask for your patience as we resolve these issues directly with the provider, which can sometimes take up to a couple of months depending on the responsiveness of your provider.
If your provider harasses you, assure them “my insurance company is in contact with your billing team to resolve this balance bill as swiftly as possible. In the meantime, I won’t be paying more than my patient responsibility as outlined by my medical plan.”
We know receiving and resolving a balance bill from a healthcare provider can be an uncertain and oftentimes frustrating experience. Thank you for hanging in there and allowing Sana and our partners to resolve these issues when they arise.
What is Sana doing behind the scenes to resolve my balance bill?
We work closely with our reference-based pricing partner, Zelis, and our claims negotiations partner, The Phia Group — both experienced experts in resolving balance bills while avoiding credit score impacts for our members. First, we assign your case to Zelis, who will reach out to you within three business days of you sending Sana your balance bill — as long as you’ve paid your patient responsibility. They’ll reach out again 7-10 business days later with a second update and more information. In the meantime, Zelis will send out a letter to your provider to dispute the charge and get a hold placed on your account while they negotiate its settlement. If Zelis can’t resolve your balance bill in this manner, they’ll escalate it to The Phia Group, who’ll review your claim details and come up with an offer strategy to settle the account. If you’ve reported a balance bill, you should be hearing from Zelis directly soon if you haven't already.
How long does a balance bill take to resolve?
Balance bills can take several months to resolve, depending on the responsiveness of the provider. Unfortunately, there isn’t anything we can do to speed the process along. If you’d like an update on a balance bill, you should contact Zelis using the email address we used when we introduced you to Zelis. If, for whatever reason, Zelis isn’t responsive within a few days, feel free to contact email@example.com and we’ll reach out to our partners with you copied to get the latest update.
What if I’m sent to collections for a balance bill?
Because balance bills can take a while to resolve, some bills will occasionally be sent to collections. If this happens, be assured Sana will call the collections agency and let them know that this balance bill is in negotiations. This way they should be able to place a hold on your account and protect your credit score. Next, we’ll inform our partners about the collections notice, and attach the notice so they can take appropriate action.
Is a balance bill the same as a surprise bill?
These terms are often used interchangeably and generally mean the same thing. In early 2022, the No Surprises Act was passed, offering protections against surprise billing. Those protections, however, are limited to non-contracted emergency services, non-contracted providers at contracted facilities, and services from non-contracted air ambulance service providers. More detail will be included with your explanation of benefits (EOB) for qualifying services.
Did I hear something about updates to credit reporting?
You sure did!
1. Starting July 1, 2022, Equifax (EFX), Experian (EXPGF), and TransUnion (TRU) will no longer include medical debt that went to collections on consumer credit reports once it has been paid off.
2. Unpaid medical collection debt won't appear on credit reports for the first year, whereas the previous grace period was six months. That will give people more time to work with their health insurers or providers to address the bills.
3. Starting in the first half of 2023, medical collection debt of less than $500 will no longer be included on credit reports.