Medicare Balance Billing

Overview
The Medicare Balance Billing Program works to protect Medicare beneficiaries from being billed by health care practitioners for amounts beyond those approved by Medicare. The program investigates complaints and takes action against those practitioners who violate the law.

The Medicare Balance Billing/Do-Not-Resucitate information line is 1-800-899-7127.

Services
The program investigates allegations of balance billing and provides an information line for those who seek information about balance billing.

"Balance billing" means charging or collecting from a Medicare beneficiary an amount in excess of the Medicare reimbursement rate for Medicare-covered services or supplies provided to a Medicare beneficiary, except when Medicare is the secondary insurer. When Medicare is the secondary insurer, the health care practitioner may pursue full reimbursement under the terms and conditions of the primary insurer, but the Medicare beneficiary cannot be balance billed above the Medicare reimbursement rate for a Medicare-covered service or supply. "Balance billing" does not include charging or collecting deductibles or co-insurance required by the program.

How to file a Medicare Balance Billing complaint
You will need copies of the various statements and bills showing the itemized billing and denial codes for each instance of alleged balance billing.

Submit a Health Insurance Portability and Accountability (HIPAA) medical information release form to the various carriers so we can obtain necessary information to investigate.

Complete the Medicare Balance Billing Complaint Form completely (see link on side bar). Attach copies of the statements.

Mail or fax the completed forms to us.

Mailing Address:
Ohio Department of Health
Medical Balance Billing
246 North High Street
Columbus, OH 43215

Telephone: (614) 466-3975
Fax: (614) 728-9169

E-mail: DNR@odh.ohio.gov

Last Updated: 3/20/08