Finally, a way to stop surprise medical bills in the United States has appeared. The law known as No Surprises Act, established on January 1, 2022, provides excellent consumer protection against those health bills that appear surprisingly after receiving emergency or outpatient services.
At Dulcinea Insurance, we suggest you keep reading this post, because with information accessible to your understanding, we have prepared a summary of everything this important law says, which in one way or another benefits everyone: those who are protected by health insurance in the USA, but also those who at this moment do not have any active coverage. If you have any questions left, we look forward to your call at 786-910-9487 and one of our licensed insurance agents will help you for free.
The No Surprises Act benefits everyone
The new rules established by the Federal Government have come to organize what has for some time become an unfortunate trend that only harms the consumer. A wave of surprise medical bills surfaced after medical institutions charged patients extra for not being in their health insurance company's network.
Let's imagine that in an emergency, the client has to look for a hospital that is within the insurer's network. That's impossible, right? As the name suggests, in an emergency, you go to the first hospital that is nearby. Well, in this case, the health institutions were violating this premise and, by being outside the insurance network, they charged the client for many services separately.
And because they were out of network, for example, a hospital anesthesiologist would send a bill directly to the patient for them to pay, at a much higher cost than if the doctor were covered by insurance. In other words, on one hand there was the emergency bill with insurance coverage, and on the other hand there was the anesthesiologist's bill for being out of the insurance company's provider network. This type of surprise billing directly affects the patient, as they are responsible for paying thousands of dollars.
With the current No Surprises Act, if you have emergency care or simply received medical treatment that you cannot control, and you receive services from a provider outside your insurance network, the most you can be billed is the in-network cost-sharing amount of your health plan (this includes copays, deductible, coinsurance).This extends to emergency services, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, or intensivist.
Providers outside the insurance company's network cannot bill you extra charges. Health insurance will pay any additional costs directly to out-of-network providers and facilities. ```
It is important to clarify: each health insurance has its own network of providers, and you as a client must visit the doctors and health centers within that network. What we are referring to in this post and with this Law is when you must go on an emergency basis, or when you receive a treatment where you cannot control third-party services.
Important note 👌: At the health center, you may be asked to sign a Notification and Consent Form. You must read carefully, because You may be signing away your rights within the Surprise Billing Law.
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How to dispute unexpected medical bills under the No Surprises Act?
It's important to know that when you sign up for a Health insurance in the United States, whether privately or through the Affordable Care Act, ...you are securing protection against the country’s high healthcare costs. To that end, the Surprise Medical Billing Act protects consumers when they use their insurance, and even if they don’t have insurance, it still provides them with the tools to ensure they aren’t completely unprotected.
In the case of not having any active health plan at the time of attending the medical institution, you have the right to ask for a "good faith estimate" that gives details of how much the medical care will cost, all detailed. This, we reiterate, is your right by law. Here we include the costs of medical tests, prescription drugs, equipment, and hospital fees. NOTE: it is recommended that this estimate be delivered to you at least one business day before receiving the service.
In the case of receiving a surprise bill that exceeds $400 above the good faith estimate, you have the right to file a dispute. The page to file this type of surprise medical bill dispute can be found here.
At Dulcinea Insurance, we recommend that when you receive an unexpected medical bill, you follow these steps:
- Call the insurance company and check if they are aware of this debt they are charging you as a customer. Ask them to make a note in their system that they are charging you an incorrect amount for a doctor or healthcare facility outside their network of providers.
- Call the health center that's sending you the bill and dispute that they are charging you out-of-network for something that they should have charged you in-network. Always mention the No Surprises Act and state that you are invoking it.
- The health center will normally adjust your bill to a lower price, but don't accept it, because you need them to charge you the rate within the insurance.. With this, you manage to get what you pay for (Copay, deductible, coinsurance) that helps you lower your maximum annual out-of-pocket expense. Instead, if you pay it out-of-pocket, what you pay won't count towards your annual out-of-pocket maximum.
- It's important that in this claim you put both institutions in line, the insurance company and the health center. You are a mediator. It takes time and is annoying, but it works!
- If these disputes cannot be resolved by the methods described, you can file a claim with the federal agency responsible for this in the Department of Health.
If you have any questions left about this important topic, we hope you call us at Dulcinea Insurance at 786-910-9487. One of our licensed insurance agents will gladly assist you with clearer information. We hope this post has been very helpful to you.
