A medical emergency is hard enough, but the pain may only worsen when huge bills arrive. Even if you have insurance. So how does one go about eliminating unexpected medical bills? Well, here’s how.
No Surprises Act
A federal law called the “No Surprises Act,” effective January of 2022, banned “surprise billing” or “balance billing.” Before the law passed, specialists like anesthesiologists could set their fees independently of the agreed-to costs between an insurer and a facility within the approved insurance network. Now, specialists’ fees will no longer land on patients receiving treatment from out-of-network specialists at in-network hospitals. Patients must be billed no more than the in-network rate, regardless.
Unexpected Medical Bills Example
Suppose that you underwent emergency surgery for some reason. Your surgery is at a hospital that participates in your insurance. Post-surgery, you receive an eye-popping bill from the anesthesiologist in addition to the surgery bill. So now what?
Medicare, Medicaid, and other government programs like Tricare have forbidden “surprise” billing across the board, whether in an emergency or non-emergency situation. Patients getting additional bills for independent services should talk to the person at the facility responsible for insurance issues or call 1-800-MEDICARE.
The new law has some significant advantages for patients but also contains three serious gaps.
1. Beware of the “Surprise Billing Protection Form”
Be cautious of signing a form headed “Surprise Billing Protection Form.” Signing it waives your rights under the new law, and out-of-network providers are free to charge you the higher rates. If you’re asked to sign on an iPad, ask to see the actual form. Don’t sign if it is the so-called protection form. If you decline, healthcare providers can also refuse to treat you. If so, you might need to shop around for another provider.
If you are undergoing non-emergency treatment, you must receive this form at least three days before the procedure. For same-day service, you should receive at least three hours’ notice. The form should clarify that out-of-network costs will be more expensive and that you can avoid that increased cost by choosing in-network doctors who are available to provide the same care at a more economical rate.
Remember that if you have a high deductible on your insurance, it might be an idea to pay cash out of pocket.
2. Ambulance Fees
The law covers costly air ambulance services in rural communities but does not apply to ground ambulance charges.
3. The new law applies to hospitals
It might not cover lab testing through doctors’ offices, visits to birthing centers, or most urgent care facilities. Ask the clinic if they are part of your insurance plan’s network. If you ask, “Do you take my insurance?” the provider could say “yes,” meaning the provider can submit the forms to your insurer and still charge out-of-network rates.
If you need emergency care and are covered by an HMO or private insurance, don’t go to an urgent-care clinic if you can avoid it. But if your only option is an urgent care clinic and you feel forced to sign the clinic’s form, do this. On the form, handwrite “signing under duress due to emergency.” Take a picture of the form with your note and report the problem to the federal hotline at 800-985-3059. You can also start a payment dispute online at CMS.gov. Your state insurance department may also take appeals.
Even if you end up paying the bill, your complaint will be registered and maybe one day Congress will eliminate the gaps in the “No Surprises Act.” We hope you found this article helpful. Please contact us today at 877-585-1885 to schedule a free consultation to discuss your legal matters.
Thanks for reading.
Christopher E. Botti, Esq., Certified Specialist in Estate Planning, Trust and Probate Law