Balance Billing

 Revised and approved by the ACEP Board of Directors titled, "Balance Billing" April 2009
Reaffirmed by the ACEP Board of Directors October 2008
Originally approved by the ACEP Board of Directors as a policy statement titled, "Prohibition of Balance Billing" October 2002 replacing Council Resolution CR31 with the same title  

The claims of all physicians who provide emergency care for commercially insured services are often paid by health plans at rates that are substantially below the reasonable and customary value of these services. This occurs in part because plans base payment on usual and customary charge data that is flawed¹. Health plans know that emergency medical care must be provided to their enrollees no matter how poorly the plans pay for these services. Systematic underpayment of emergency services without a corresponding system of ensuring fair payment has led to the need to preserve balance billing. This ensures the viability of patient care services where there are no enforced laws or regulations requiring health plans to pay emergency care provider claims at appropriate rates sufficient to maintain the financial viability of our nation’s emergency care safety net.

1. As determined by the New York Attorney General.