(DailyAnswer.org) – Thanks to a new No Surprises Act, those bills that come in that you’re not expecting don’t have to mean financial devastation anymore. Learn about the No Surprises Act, what qualifies as a surprise medical bill, and see how to fight them in this concise overview.
What is a Surprise Medical Bill?
Medical bills that arrive unexpectedly, whether due to a facility being out-of-network or otherwise, are termed ‘surprise medical bills’. It is bills that are not covered entirely by your insurance because of being out-of-network, typically seen in laboratory testing and anesthesiology billings.
What is the No Surprises Act?
The No Surprises Act, or NSA, became effective on January 1, 2022, and helps those with an individual or group health plan. The NSA protects by banning:
- Out-of-network copayments or cost-sharing for Emergency (and some non-emergency) services
- Unexpected Emergency out-of-network services bills that do not have prior authorization
- Out-of-network charges for any supplemental care fees like anesthesiology, imaging, or laboratory, when they work in a facility that is in-network.
The No Surprises Act may not ban urgent care facilities, ground ambulances, retail clinics like CVS, addiction/rehab treatment facilities, hospice clinics, or birthing centers.
Fighting a Surprise Medical Bill
If you receive a surprise medical bill, here are four things to remember.
Don’t pay when you receive it – first, you will want to contact your insurance company and see if this bill has been submitted to them. If not, then call the company the bill is from and have them submit it to your insurance. You will need to get an explanation of benefits form sent from your insurance company showing what part of the bill they paid. Any out-of-network provider cannot charge more than what is shown on the explanation of benefits paper as the in-network cost-sharing amount that was shown there.
Ask for an itemized bill – when you receive an itemized bill you are able to go over it and look for errors. There may be duplicate charges or charges for things you did not have done or didn’t receive. After checking for errors, report any that you found to the insurance company and to the facility that sent the bill. It has been shown that roughly 50% of all medical bills will contain an error.
File complaints – if you have a surprise medical bill that came in 2022 or later, and you can’t get it resolved, you may want to file federal and state complaints. For federal complaints, you can file them online, and have all your bills and documentation ready. For state complaints, you can file with the Consumer Assistance Program in your state.
Check for special circumstances – If you are uninsured, several of the above guides will not help you. However, you must receive a “good-faith estimate”. If the final bill is over $400 different from that estimate, you can complain to the Centers for Medicaid and Medicare Services. After filing, that bill can not go into collections and there will be no late fee assessed until the complaint has been heard and resolved. Also, there are several patient advocacy groups that can help someone with medical bills. Call 800-532-5274 and talk about your situation and the bills received and they may be able to help.
There have been guidelines set into place to help rein in uncontrolled surprise medical bills but there will always be some that slip through. By being diligent to always go over your billing and checking for errors, you’re being proactive to ensure that you are only charged for what was received and what is reasonable.
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