New federal law aims to end maddening surprise medical bills

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Ssay goodbye to surprise medical bills.

The federal No Surprises Law, which protects consumers with private health insurance by prohibiting most surprise bills from off-grid providers, came into effect on January 1.

In the past, many patients who received emergency care from a facility or doctor outside their network – or scheduled elective care involving an unemployed doctor – faced unexpected bills afterwards. their treatment. These bills often came from medical providers that were difficult (if not impossible) for patients to research ahead of time: you could do your homework and make sure your primary surgeon participated in your insurance plan, for example. example, only to have a non-participating anesthesiologist treat you before surgery.

But now those bills should be gone.

“Thanks to new rules to protect consumers, excessive reimbursable costs will be limited and emergency services must continue to be covered without any prior authorization, whether or not a supplier or installation is on the network.” , according to the US Centers for Medicare & Medicaid Services.

Some states have laws in place to protect consumers from surprise bills, but this is the first comprehensive federal legislation to address the subject.

Air ambulances are also included in the No Surprises Act, so there shouldn’t be any surprise bills if you need to be airlifted for medical treatment. Be warned, however, that ground ambulances are not included in the No Surprises Act. So, you might still face surprise medical bills if you need a traditional ambulance ride.

Lawsuits against medical providers are ongoing, but are unlikely to impact the ban on surprise bills. (If the lawsuits are successful, however, they could lead to increased health insurance premiums, according to the Center on Health Insurance Reforms at the McCourt School of Public Policy at Georgetown University.)

How common are surprise medical bills?

Previously, receiving a surprise bill from an off-grid provider after emergency care was common. Among privately insured patients, about one in five emergency claims and one in six hospitalizations in the network included at least one out-of-network bill, the Kaiser Family Foundation reported in 2021.

And two in three adults say they worry about unforeseen medical bills, which can cost hundreds or even thousands of dollars, according to the foundation.

What if you receive a surprise medical bill?

In the past, out-of-network providers often billed patients directly. Then the patient should submit this off-grid claim to their insurance and collect any possible reimbursement, according to the Kaiser Family Foundation.

Under the new law, providers must submit the off-grid surprise bill to the patient’s health insurance plan, which must then notify the doctor or hospital of the network’s cost-sharing amount for the claim. The health insurer will then send an upfront payment to the provider, and the patient will receive a explanation of benefits (a statement explaining what was covered and what the patient owes to the non-network provider).

Only after all this can the off-grid provider send an invoice to the patient. Importantly, the bill cannot exceed what you would have had if the providers had accepted your insurance, adds the Kaiser Family Foundation.

If you receive an invoice from a non-network supplier greater than the amount indicated in your explanation of services, you should ask your provider for a revised bill, according to the Center on Health Insurance Reforms. If this does not resolve the problem, file a complaint with the federal “No Surprises Help Desk”. in line or by phone at 1-800-985-3059.

Keep in mind that although federal law prohibits surprise billing, consumers are still responsible for all network costs – and figuring them out can still be complicated. For tips on how to cut medical bills, check out Money’s guide to saving money on medical bills, prescription drugs, and more.

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