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In the struggle between health insurance companies and hospitals to decide who pays what, it's often the consumer who ends up stuck with the bill, and this is especially the case when it comes to "balance billing."

As it's explained at Sign on San Diego, balance billing is the process by which too many consumers are forced to pay for medical bills that ought to be covered by their health insurance.

The process goes something like this: a sick or injured person goes to the emergency room. Their health insurance is issued the bill, but in an effort to duck the costs the insurance agency denies portions of the bills that they feel didn't come from "real emergencies" (how this is determined is not a process that's been released to the public).

The hospital then forwards a bill for the difference to the consumer, who shouldn't have to pay it but usually does. After all, they have health insurance, which should cover a specified amount in terms of emergency care.

However, some people pay it because they mistakenly assume it's their copayment. Others are afraid to get into trouble with creditors, and end up paying bills on medical debt that they simply can't afford.

In response, doctors and hospital officials met today with health insurance companies in San Diego over a state plan that would make it impossible for hospitals to bill patients for emergency room care. Hospitals would then have to take their claims directly to insurers to get the problem resolved.

Hospital officials argue that they can't afford the time/money required to take insurance agencies to court. Insurance agencies argue that they're expected to pay for things they think they shouldn't.

Somewhere in between are consumers, stuck paying for things they shouldn't have to pay, until the big guys can find a way to settle their own disputes.