New Consumer Protection Law Bans “Surprise” Bills from Out-of-Network Healthcare Providers
When a medical issue arises, whether it is an injury or an illness, finding the right treatment as quickly as possible is the top priority. At least, it should be the top priority. In reality, too often people who are injured or suffering from an illness or other medical problem must first consider where and from whom they are receiving said medical attention. They must confirm that the medical facility and provider are in-network participants in their insurance plan.
If the facility and provider are not in-network and the patient receives treatment anyway, the patient runs the risk of receiving an unexpectedly large bill later.
When a medical issue arises, whether it is an injury or an illness, finding the right treatment as quickly as possible is the top priority. At least, it should be the top priority. In reality, too often people who are injured or suffering from an illness or other medical problem must first consider where and from whom they are receiving said medical attention. They must confirm that the medical facility and provider are in-network participants in their insurance plan. If the facility and provider are not in-network and the patient receives treatment anyway, the patient runs the risk of receiving an unexpectedly large bill later.
These bills, referred to as “surprise” bills, are often for the balance between the amount the provider bills and the amount the insurance company agrees to pay for services from an out-of-network provider. However, in good news for consumers, a new federal consumer protection law that went into effect on January 1, 2022, puts an end to such billing practices.
According to a report by The Washington Post, the new law – dubbed the “No Surprises Act” – prohibits providers from sending “eye-popping bills to insured patients who inadvertently get care from an out-of-network provider.”
The impact of the No Surprises Act will be widely felt: the Kaiser Family Foundation, a nonprofit organization that focuses on national healthcare issues, estimates providers send approximately 10 million out-of-network surprise medical bills to patients each year.
What exactly does the No Surprises Act do?
It is no secret that skyrocketing medical expenses can create serious financial hardships or even bankrupt hardworking Americans who have the misfortune of becoming ill or suffering an injury. Even having health insurance does not guarantee the average person will be able to afford the medical care they need. Additionally, in the midst of fighting a serious illness or, for example, in the aftermath of a serious auto accident, truck accident, or other personal injury incident in Nashville, patients should not receive unexpected bills for exorbitant amounts of money for treatment they inadvertently received from an out of network healthcare provider.
The No Surprises Act is a consumer protection law designed to put an end to the millions of unexpected and excessive bills sent to insured patients who received medical care from an out-of-network provider.
These billing protections include when a patient receives emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
Is anything not included in the No Surprises Act?
While the new law covers air ambulance services from out-of-network providers, it does not include ground ambulance transportation services. This means you may still receive surprise bills from a ground ambulance transportation provider if it is an out-of-network provider.
What does the No Surprises Act mean for you?
If you or a loved one receives emergency or non-emergency care from an out-of-network provider at an in-network facility, you have new billing protections as an insured patient. Under the new federal law, providers’ excessive out-of-pocket costs are restricted, meaning you cannot be charged an unreasonable amount for the treatment and services you received. You will still be responsible for paying any in-network cost sharing amounts.
Insurance companies must continue to cover emergency services without prior authorization regardless of a provider’s in-network status. So, if you or someone you love seeks emergency medical care – perhaps in the event of a car accident or other unexpected situation – you do not have to worry about confirming that the facility to which you are transported and the healthcare professionals who take care of you are part of your health insurance plan’s network. Your medical treatment will still be covered by your insurer and you can focus on your health.
What if you still get a surprise bill for medical services?
The high volume of surprise bills being sent to patients typically numbers in the millions each year. Experts predict it may take some time for that to change. In fact, if you do receive a surprise bill, it is your responsibility to correct the issue.
Under the new law, the federal government was required to establish a national consumer complaints system for patients who receive surprise bills. That system is now in place. By calling a toll-free number (1-800-985-3059) or submitting a complaint online, patients can access federal assistance in investigating their surprise medical bill. Since launching on January 1, 2022, the help line has already received more than 300 calls. The Washington Post reports that, according to a spokesperson for the Department of Health and Human Services, most of the calls were from consumers who wanted to know more information about the new ban.
A substantial number of Americans live paycheck to paycheck, sometimes working more than one job just to put food on the table and keep a roof over their and their family’s heads. An unexpected and excessive medical bill from an out-of-network provider could be financially devastating – even for someone with good, employer-based healthcare insurance. This new consumer protection law is an important step toward protecting these hardworking people from financial ruin due to surprise medical bills.
It is certainly our hope that the No Surprises Act proves to be effective at protecting consumers from surprise medical bills in the event they inadvertently receive medical care from an out-of-network provider. Illnesses and accidents happen every day, leaving people in need of specialized care and increasing the odds that you could be treated by an out-of-network provider. If that does happen and your injuries were caused by an auto accident in Tennessee, Rocky McElhaney Law Firm can help. From our offices in Nashville, Hendersonville, and Clarksville, our personal injury attorneys represent clients in personal injury and workers’ compensation claims throughout Tennessee. Call us today at 615-239-0119 or complete our contact form to schedule an appointment to discuss your case.