In response to last week's emails about balance billing, one of the listserv participants has forwarded to my attention a letter from Horizon Blue Cross Blue Shield of New Jersey, dated August 2009, that addresses the routine waiver of applicable co-payments by non-participating providers.  The letter details that in response to this activity, Horizon is suing "various" nonparticipating providers, explaining that:

"By waiving member deductibles, copayments and coinsurance amounts, nonparticipating providers are overstating and misrepresenting the actual charges for the services they provided.  In the context of Medicare and Medicaid fee-for-service, the Office of Inspector General has already identified the waiver of copayments and deductibles as a potential violation of the Medicare and Medicaid Anti-Kickback Law."

Action taken by Horizon NJ against providers is a prime example of how practices may be targeted for failing to balance bill.  It is important that you make every good faith effort to balance bill.


For additional information on this topic, contact Jennifer Kirschenbaum at (516)-747-6700 ext. 302 or at

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