Advocates of balance billing argue that it increases the incomes of high-quality healthcare providers and measures their dissatisfaction with insurance company fees.
[5][6][3] In 2002, five provinces prohibit all extra-billing, while Alberta, British Columbia (BC), and Newfoundland allow it in a small number of circumstances, and Prince Edward Island and New Brunswick do not restrict it at all.
In 2018, the government announced its intention to implement operational requirements more stringently and to impose financial penalties for extra billing for medically necessary diagnostic procedures.
[12] However, out-of-network medical billing has become common for privately insured patients even when they receive care in an in-network hospital, creating a substantial financial burden.
[14] The "growing risk to patients of incurring burdensome unexpected out-of-network bills" has received significant attention in the 21st century.
[15] A 2020 Peterson-KFF Health System Tracker found that, "for people in large employer plans, 18% of all emergency visits and 16% of in-network hospital stays had at least one out-of-network charge associated with the care in 2017.
[17] Researchers consider a state to offer "comprehensive protections" against surprise bills if the state's law limits a consumer's "financial exposure to normal in-network cost sharing"; bars providers from balance billing; applies to both emergency department and non-emergency care in an in-network hospital; applies to both HMO and PPO enrollees; and creates a method for resolving payment disputes between providers and insurers (either through a specific payment standard or a dispute resolution process).
[17][18] The states with a comprehensive approach are California, Connecticut, Florida, Illinois, Maryland, New York,[18] Colorado, New Mexico, and Texas.
In response to successful challenges to such flawed databases, some plans have established out-of-network benefit rates that are still substantially below usual and customary payments.
[26][27] In France, physicians who want to charge more than the government-negotiated set fees are considered to be in a separate "payment sector," which essentially means they are treated as self-employed.
Today, patients in Taiwan are allowed to choose more expensive versions of some devices such as stents, implants or prosthetics, and to pay the difference in cost themselves.