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No More Surprise Medical Bills: U.S. Law Enters into Force Protecting Americans from Huge Hospital Debts

On January 1, 2022, the No Surprises Act will enter into force. CNBC.

Photo: Shutterstock

This law will prohibit most forms of unexpected billing or balance billing in which a person unknowingly receives care from an outside provider, even when visiting an intranet facility.

According to Kaiser Family Foundation, this is a common scenario that occurs in about one in every five emergency room visits. Even if you choose a doctor or network provider carefully, you may need ancillary services during your visit that are not covered by your insurance, such as anesthesiologists, radiologists, and resuscitators.

Patricia Kelmar, director of health campaigns at the US PIRG, says these ancillary services are often in the same building as the network provider, exacerbating the confusion over what is actually covered.

“They use people in the most vulnerable situations,” she says, arguing that patients are unable to control their coverage, especially when they receive emergency care.

“The last thing you do at this stage is check the status of the insurance network and ask for a cost estimate,” adds Kelmar.

How Surprise Medical Billing Protection Works

The new rules apply to private insurance companies, including those provided through the Affordable Care Act marketplace (surprise billing is already prohibited under Medicare and Medicaid).

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From January 1, patients should not receive an unexpected medical bill from an out-of-network provider if:

  • When you get help in the emergency room
  • When you receive any treatment at a network health facility
  • When you are transported by air ambulance (plane or helicopter)

In addition, emergency providers cannot charge you for out-of-network services when you are stable unless you consent and can freely move on your own to an available provider within your network.

In these scenarios, the consumer will no longer be the intermediary between their provider and the insurer and will only pay on-net costs.

Any outstanding balance must be settled between insurers and out-of-network healthcare providers. The law gives insurers and these suppliers 30 days to resolve inconsistencies, and there is a new arbitration process to resolve disputes.

Limitations for consideration

Location matters.

These new federal protections only apply to emergency departments and emergency centers that provide emergency services. They are also used in hospitals, clinics and outpatient surgery centers that are part of the insurance network.

However, these protections do not apply to non-emergency services provided in other settings, such as drug treatment facilities, maternity hospitals, clinics, hospices, nursing homes, or emergency centers that are not licensed to provide emergency services.

You should always check that these facilities and the services they provide are part of your network, especially for emergency centers.

The No Surprises Act also does not apply to ground transportation of ambulances, even if you have little control over who provides the service.

Kelmar says this means you can still get an ambulance bill outside of your network. Some states do offer protection against unexpected ground ambulance bills, otherwise your best bet is to call an ambulance and try to negotiate your bill.

How to avoid surprise bills

When dealing with a healthcare provider, it can sometimes be difficult to get a clear answer about exactly what your insurance company is covering. Kelmar suggests asking, "Are you a member of my plan's network?" not, "Do you accept my insurance?" Since that will tell you more about what to expect in terms of actual costs.

Out-of-network doctors may ask you to sign a Contingency Coverage Form.

Kelmar recommends not signing it until you have read it in full and you have a full cost estimate.

You may be interested in: top New York news, stories of our immigrants, and helpful tips about life in the Big Apple - read it all on ForumDaily New York.

Emergency physicians, surgical assistants, anesthesiologists, radiologists, and resuscitators are not allowed to ask you to sign this form. If you do sign this form and it turns out to be $ 400 more than expected, you can dispute the invoice by filing an online complaint here or by calling 1-800-985-3059.

If you receive an unexpected medical bill after January 1, 2022, contact your service provider and insurer immediately. If they still insist on payment, you can file a complaint within 120 days online here or call 1-800-985-3059.

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