Avoiding Surprise Bill and Complications with a Recent Regulation

People are fortunately now not obligated to cover care received that was not part of the network if the care was given without that person’s consent. This is the result of a healthcare law that became effective at the beginning of 2020 and could lead to fewer insurance payment issues for many people.

The law’s safeguards from expensive medical bills, however, are only as valuable as a person’s awareness, understanding, and capacity to ensure enforcement of the protections occurs.

Surprise Bills Are Common

Studies have revealed that a fifth of visits to the emergency room results in unexpected bills.

Bills a person does not anticipate are often generated by physicians in the emergency room as well as other specialists not covered by insurance held by the person pursuing medical care. The patient also routinely has no power over selecting these individuals.

Before the measure became effective, a person would need surgery, select a hospital within the patient’s network that accepts health plans, and proceed from there. If a treating physician does not accept your insurance, though, you will receive a large insurance bill, which will be separate from bills issued by hospitals and other physicians. You will be slated to pay off whatever the new balance is.

The Role of the No Surprises Act

The new regulation dubbed the No Surprises Act states that individuals who pursue care from in-network providers cannot receive a bill whose dollar amount is more than what they negotiate or the rate that would have occurred if the service fell within the network for any type of outside healthcare network service received.

Health care can be frightening. You’re not alone to face health care issues, though. Instead of letting a patient face an unanticipated bill, the law states that insurance carriers and health care providers must now address how bills are paid. The law also leaves room for medical providers who are interested in pursuing other bypasses for protection. 

While protections created by the law apply to medical facilities, these protections do not apply to other locations including doctor’s offices or urgent care locations. Air ambulances fall under the law, though, while ground ambulances exist outside this regulation.

How Some Healthcare Entities Try to Deal with Surprises

Outside of network providers sometimes give patients a form addressing the individual’s protection from unanticipated costs. Signing these bills waives protection and provides consent to treatment received at out-of-network rates. 

Your consent should be given at least 72 hours before care is received or if service is scheduled on the same day no more than three hours in advance. If you’ve waited to schedule a procedure with a specialist, 72 hours often do not feel like sufficient advance.

Forms should include an estimate in good faith of the amount you will be charged. For non-emergency situations, the form should list the name of in-network providers you would prefer to see. 

These forms should update you that a medical provider can decline to provide treatment if you refuse to waive your protections. Additionally, it’s against the law for some providers to hand you this form. Some providers are forbidden from handling these forms including emergency room doctors, radiologists, and assistant surgeons.

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