At the end of 2020, Congress enacted into law the No Surprises Act
, creating new consumer protections against surprise medical bills as part of the new Coronavirus Aid bill. Surprise billing happens when a patient seeks care at a medical facility within their network and afterwards is billed unexpectedly because the doctor that treated them is out of network. Surprise billing can amount to millions of dollars for Americans each year with 1 in 5 emergency claims including at least one out-of-network bill. Here are some of the provisions created to protect consumers:
Health Plans Have to Cover Surprise Billing
Private health insurance plans must cover surprise medical bills for emergency services as well as services of out-of-network providers rendered at a facility that is in the network. The law also requires in-network cost sharing to apply to these services. If a private insurer does not correctly identify or cover a surprise medical expense, the consumer will have the right to appeal the decision.
Balance Billing Is Not Allowed
A balance bill is issued to a patient when a health provider charges them the amount not covered by the insurance company. Out-of-network providers are prohibited from charging patients beyond what the in-network cost sharing cost is for services rendered. There is an exception for out-of-network doctors providing non-emergency services that provided advanced written notice of the cost and received the patient’s consent.
Out-of-Network Providers Cannot Bill for Excess Charges
The law specifically indicates that out-of-network providers cannot hold patients liable for costs that exceed the in-network cost sharing for a specific service. This places the burden on providers to know a patient’s insurance status as well as the in-network cost sharing for the bill.
Oversight and Enforcement of these Rules are Required
Private healthcare providers, state providers, and federal providers must all follow these rules and create specific mechanisms of oversight and enforcement. There must be a process in place for receiving complaints and reports of surprise bill violations. Violations can result in penalties of up to $10,000 per violation.
How Will Surprise Bill Payments Be Resolved?
While consumers will now be protected from surprise billing, the cost of these services must still be paid. Congress finally compromised on an independent dispute resolution (IDR) process to resolve surprise bills. The IDR process would allow the insurance provider and the health services provider to try to negotiate the payment amount. Each party will submit a final offer and within 30 days the IDR entity will determine which offer is the most fitting.
With over 150,000 coronavirus hospitalizations in 2020 alone, many Americans are dealing with the cost of emergency medical care. Protecting consumers from surprise billing is one way Congress is working to lighten the load of overwhelming medical debt. The provisions of this legislation are intended to go into effect January 1, 2022.
If you are currently dealing with unmanageable medical debt, whether due to COVID-19 or not, don't let it push you into financial ruin - you have options
! Call Veitengruber Law
609-297-5226 today so we can help you determine the best path forward and start negotiating your medical debt down to a reasonable level ASAP.