MTBC Medical Transcription Billing Corp Complaint - MTBC violates prohibitions on balancing billing
SOMERSET, NEW JERSEY -- Despite repeated attempts to get MTBC customer service to provide the HMO with the information needed to process the claims I was instead sent numerous bills, which in my opinion constitutes a violation of the New Jersey state balancing billing law and the contractual obligations the provider had with the HMO.
Additionally in my opinion MTBC violated Public Law 95-109, Section 805-C when I received another bill after I and the provider requested no further bills be sent to myself or my daughter.
New Jersey HMO Law.
Pursuant to New Jersey law, an HMO must limit its members' liability for services rendered at an in-network hospital to the amount of the co-payment, deductible and/or coinsurance. See N.J.A.C. 11:22-5.6(b). Likewise, an HMO cannot require a member to pay more than his or her co-payment, deductible and/or coinsurance with regard to emergency care rendered at non-participating hospitals. See N.J.A.C. 11:24-5.3(b). Finally, a member cannot be obligated to pay any amount in excess of his or her co-payment, coinsurance and/or deductible obligation for services rendered by a non-participating provider if the HMO referred the member to said provider. See N.J.A.C. 11:24-5.1(a).
Collectively, the above-referenced regulations provide that a member cannot be compelled to pay anything above-and-beyond the member's co-payment, coinsurance and/or deductible relative to care rendered by a participating provider or a non-participating provider if the member was referred to the provider by the HMO or the care constituted emergency services. With regard to such services, a payer must pay the non-participating provider's reasonable and customary fees. Balance billing is not permitted.