Talk:Balance billing

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In Fine Print, HHS Seems To Have Banned Surprise Medical Bills During The Pandemic

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 September 2019 and 13 December 2019. Further details are available on the course page. Student editor(s): Anjpatel, Mmkhoshab, NLe12, Scriptsolv. Peer reviewers: Letony331, Kchun, Wu.Marilyn, Joanna.sy.choi.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 17:48, 17 January 2022 (UTC)[reply]

CP133 2019 Group 28 proposed edits

Proposed Edits: Surprise Billing https://en.wikipedia.org/wiki/Balance_billing

ADD under the United States: In 2019, the California legislature created a bill to oppose surprise billings under AB1611. AB1611: Patient Protections Against Surprise Emergency Room Bills and post-stabilization care protect individuals from receiving a medical bill from an out-of-network hospital for more than their network copay, deductible, or cost-sharing.
Under the US: Adding citation from current studies and stats of out-of-the-pocket costs for example https://www.ncbi.nlm.nih.gov/pubmed/31403651
AB 72- out-of-network coverage effective in 2017: This out-of-network billing and payment law was to protect patients from unexpected medical bills when they go to see an out-of network doctor in-network clinic. Out-of-network physicians can charge extra as out-of-network balance billing.
Change balance billing definition by citing HealthCare.gov

“Balance billing, sometimes called surprised billing, is a medical bill (wikicite) of a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays. (cite)” — Preceding unsigned comment added by NLe12 (talk • contribs) 04:31, 17 October 2019 (UTC)[reply]

Added six states comprehensive approach

The six states with a comprehensive approach were California, Connecticut, Florida, Illinois, Maryland, and New York.^[1] A comprehensive approach had laws that applied to both HMOs and PPOs, provided protection to emergency department and in-network hospital settings, and prohibited providers from balance billing by creating payment standards or outlining a process for disputing medical bills between providers and insurers.^[1] Anjpatel (talk) 04:33, 23 October 2019 (UTC)anjpatel[reply]

Added EMTALA

In 1986, Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA) to ensure that individuals seeking emergency services had access to care. Because of this Act, health services required to provide care regardless of an individual’s ability to pay for the service. Insurance companies may only cover specific costs which would then require individuals to pay the remaining balance out-of-pocket after the service is performed. ^[2]Anjpatel (talk) 17:00, 31 October 2019 (UTC)Anjpatel[reply]

Added cost for ED bill

out-of-network emergency department (ED) medical bill increased from 32.3% to 42.8%. Mmkhoshab (talk) 04:33, 10 November 2019 (UTC)Dkhoshabafard[reply]

CP133 2019 Group 27 Peer Review

Group 28's edits substantially improved the article through greatly expanding on the United States section of the article. An evaluation of the quality checklist for Wikipedia articles shows that it has a short simple title, a direct first sentence, and a lead section that successfully summarizes the argument for and against balance billing, without persuading the reader to support or reject balance billing. The article does not contain excessive quotes and appropriately uses lay language. Based on the goals listed in the group's proposed edits, it seems like the goals have been met. They have kept the article up to date by discussing Congress's current legislation on balance billing and the states that have successfully approached the concept of balance billing. Specifically, they mention California's AB 72 and AB 1611. This draft submission most definitely reflects a neutral point of view in that it encompasses an unbiased definition of balance billing and states the viewpoints of both the "advocates" and "critics" in the introduction section. In the section that discusses the balance billing in the United States, the writers provide an unbiased history and the current legislation without using language that attempts to persuade readers. Great job! Kchun (talk) 09:33, 4 November 2019 (UTC)[reply]

Overall, I think that the group has reached their edit goals. For example, I really liked how Nhi Le's edit clarified what Balance Billing was by using Healthcare.gov as a source. Healthcare.gov is meant to be accessible and easy to understand for the lay-people and is clear to a non-expert reading the material. Anjali Patel did a great job explaining EMTALA and properly citing her source. I liked how ScriptSolv added a clarification for California on the two bills AB 72 and AB 1611. As a future edit idea, more information could be expanded on the other states, so it would not be so biased to California. As a critique, I don't think this was Group 28's choice, but I wanted to know whoever added the headers the first time, why these specific countries were chosen over others. Are there more countries that prohibit or allow balance billing? Overall, the article maintains a neutral tone and does not try to persuade the reader to support or oppose balance billing in the country. Letony331 (talk) 04:08, 5 November 2019 (UTC)[reply]

Thank you for the review, we will be used to look into why those specific countries were selected. NLe12 (talk) 19:33, 21 November 2019 (UTC)[reply]

I think Group 28's edits have improved the article. The Lead is concise and gives a good summary of balance billing as well as both viewpoints from advocates and critics. However, the Lead is missing a brief description of the article's main sections - their is no mention of the six countries that are discussed in the content portion. The content is relevant and up to date. The group's goals for improvement have mostly been met with the addition of a more accurate definition of balance billing and more recent legislation regarding balance billing (AB 72 and AB 1611). One goal outlined that wasn't met was adding a current study and stats for out-of-pocket costs. I noticed evidence of plagiarism under the section titled "United States" when defining surprise balance billing, and it was also incorrectly cited. It is almost copied word-for-word from source #12 [Albright, Matthew (October 3, 2018). "Senate Bill and State Balance Billing Laws". Zelis.] but was cited as source #11 [ "Analyzing New Bipartisan Federal Legislation Limiting Surprise Medical Bills | Health Affairs". www.healthaffairs.org. doi:10.1377/hblog20180924.442050/full/.]. I'm not entirely sure if this was a mistake made by Group 28 or by others working on the page. Overall, however, I think this article was concise yet thorough in what balance billing entails and how different parts of the world address it. Wu.Marilyn (talk) 17:16, 5 November 2019 (UTC)[reply]

Thank you so much for the feedback! It looks like the plagiarized sentence was there prior to our review. Nevertheless, I have corrected it and hopefully summarized it appropriately. Please let me know if you have an additional concerns. Thanks again! Anjpatel (talk) 20:56, 20 November 2019 (UTC)anjpatel[reply]

Thank you for adding that, we included some data demonstrating ED bill is rising. Mmkhoshab (talk) 04:13, 21 November 2019 (UTC)dkhoshabafard[reply]

In addition, the edits are also edited within Wikipedia's manual of style. For example, capitalization is correct and the subheaders are short and succinct. The sentence length varies appropriately and the syntax is understandable for the general public. Letony331 (talk) 21:29, 6 November 2019 (UTC)[reply]

The group’s edits improved the article and achieved its overall goals for improvement. By clarifying the six states with restrictions on surprise balance billing and going into details about what the restrictions mean regarding patient protection, the readers are able to better understand the progress different states are making regarding affordable healthcare. Regarding EMTALA, while stating a neutral point of view, they did a great job on informing and educating the readers about what is relevant and what the Act means when it comes to emergency services and patients’ ability to afford the services. All the cited secondary sources are freely available, making it accessible for the public to get more details about a particular point that they are interested in reading more about. Joanna.sy.choi (talk) 22:45, 6 November 2019 (UTC)[reply]

References

^ ^a ^b Lucia, K; Hoadley, J; Williams, A (June 2017). "Balance Billing by Health Care Providers: Assessing Consumer Protections Across States". Issue brief (Commonwealth Fund). 16: 1–10. PMID 28613066.
^ "Balance Billing". Annals of Emergency Medicine. 68 (3): 401–402. 2016. doi:10.1016/j.annemergmed.2016.06.034. ISSN 1097-6760. PMID 27568434. Retrieved 30 October 2019.

Suggested RS

Young, Kerry Dooley; June 16, Journalist's Resource; 2020 (2020-06-16). "Surprise billing: When people with medical insurance still face high costs". Journalist's Resource. Retrieved 2020-06-30. {{cite web}}: |last3= has numeric name (help)CS1 maint: numeric names: authors list (link) Oceanflynn (talk) 15:36, 30 June 2020 (UTC)[reply]
Bold 103.175.57.38 (talk) 22:15, 11 August 2024 (UTC)[reply]

[Lucia-1] Lucia, K; Hoadley, J; Williams, A (June 2017). "Balance Billing by Health Care Providers: Assessing Consumer Protections Across States". Issue brief (Commonwealth Fund). 16: 1–10. PMID 28613066.

[2] "Balance Billing". Annals of Emergency Medicine. 68 (3): 401–402. 2016. doi:10.1016/j.annemergmed.2016.06.034. ISSN 1097-6760. PMID 27568434. Retrieved 30 October 2019.

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