What to do when you receive a surprise medical bill
What to do if you receive a surprise invoice
Even with the new law in place, experts say it’s still important for policyholders to be careful when reviewing their medical bills. After all, with around 10 million surprise bills sent out each year, a few cases could “fall through the cracks,” Hoadley says. “I think that at the end of the day this should be a situation where the consumer just doesn’t have to think about it, but at first it probably won’t be for everyone,” he adds. .
First of all, it’s important to know the difference between a surprise bill when it comes to the new law and a bill that’s surprisingly more than you expected. Plans with high deductibles or coinsurance can still generate high bills, so find out what your insurance covers and be aware that if you have a high deductible you will need to pay it off before cost sharing begins.
“You could be running out of $ 2,000 for a medical procedure that’s completely in the network, that’s a totally appropriate bill, you just haven’t hit your deductible,” Hoadley says. “So it’s a surprise, but it’s not what we call a surprise bill in the case of this law.”
Second, know what to look for: Duffy says surprise bills usually come from a group of doctors or a lab, for example, and not necessarily from the hospital or healthcare facility where you received care. So if you notice a separate bill from your hospital bill, “this is when you want to take a closer look,” she says. Compare this invoice to the explanation of benefits sent by your insurer and see if there are any discrepancies. An invoice that suggests that you owe a balance greater than your co-payment or your expected deductible in the network is a red flag.
If you think you were wrongly billed for your care, call your insurer first. You can also call the supplier for an explanation – it could just be the result of a billing error. If you still don’t get your questions answered, the Department of Health and Social Services has a new complaint system for surprise bills; the No Surprises Helpdesk number is 800-985-3059.
And don’t forget: the new protections come into effect on January 1, so it is possible to receive a legal surprise bill after this date for a treatment that was administered before the entry into force of the law.
Patients who wish to receive elective care from a health care provider who is not part of their health insurance plan network – for example, they wish to schedule a knee replacement with a specific orthopedic surgeon – will be able to still do so under the new law, by way of a waiver. This waiver must be signed prior to the procedure or appointment; the patient should also receive a “good faith estimate” of the cost of their care. “But you can never be asked to sign this type of waiver for an auxiliary supplier.” [like an anesthesiologist or surgical assistant] under the No Surprises Act, ”says Duffy.
Another thing to note about the new law is that it does not cover ground ambulance transportation, a common source of surprise medical bills, although several states have laws prohibiting off-grid ambulance charges. So it is always possible to get a high bill for your trip to the hospital. You may also have to pay unforeseen charges if you are transferred from one hospital or healthcare facility to another using an off-grid ambulance.
If you find yourself in a non-emergency situation where you or a family member can confirm the status of an ambulance company network in advance – for example, if a patient is transferred from a hospital to a nursing home – it’s a good idea to do this, says Duffy. “There are still areas where we must be vigilant,” she adds.
Finally, pay attention to where you receive the treatment. These new protections only apply to care provided in hospitals, hospital outpatient departments and outpatient surgery centers. They do not apply to non-emergency services provided in other facilities such as birthing centers, clinics, hospices, addiction treatment centers, nursing homes and many nursing homes. emergency, explains KFF. Patients will want to check ahead to make sure their healthcare provider is considered part of the network before seeking care at these facilities.
Hoadley also advises patients to inquire about the state of the imaging center network if they are referred to one by a primary care physician, to avoid unforeseen charges.
Rachel Nania writes on health care and health policy for AARP. Previously, she was a reporter and editor for WTOP radio in Washington, DC. A recipient of a Gracie Award and an Edward R. Murrow Regional Award, she also participated in a Dementia Research Fellowship with the National Press Foundation.