“Surprise” bills for medical care could go down in history after the “No Surprises Act” came into effect on January 1, which seeks to prevent insurance companies from charging patients for out-of-network services.
The new law, which was approved at the end of 2020, provides federal protection to patients from unexpected charges from out-of-network providers.
This occurs when a patient is charged the difference between the out-of-network provider’s fee and the amount covered by your health insurance, after copays and deductibles.
In many cases, people have no idea that they are receiving medical care from out-of-network providers and that they will have to pay the difference as they are not informed.
Charges for out-of-network services are more common in emergency care, such as emergency rooms or hospitals, and in situations where patients cannot necessarily choose where to go. But these additional charges are also reported in non-emergency hospitalizations where multiple providers provide services. Even where health insurance is supposed to cover hospitalization, some providers, such as anesthesiologists or radiologists, are not in the network, and then consumers must pay for those services.
Under the new statute, private insurance companies must cover certain out-of-network bills and apply copayment and other costs as if the care were provided by an in-network provider.
According to the Forbes report this week, the law prohibits doctors and hospitals from charging consumers more than they would have to pay for services. as if the providers were in the network with the insurance company.
The No Surprises Act applies to bills for emergency services from hospital emergency rooms, freestanding emergency facilities, and urgent care centers providing emergency services.
The provision further covers transportation by air ambulance, although not terrestrial; and non-emergency services whose providers are not in the network and bill separately.
Hospitals and healthcare providers have one year to prepare for the implementation of the law.
In addition, under the act, the providers should publicly notify patients of new protections regarding invoices.
Patients will also have the option to appeal charges they deem unjustified to their insurance company. If the request is unsuccessful at that level, the person can turn to an external entity to settle the allegation.
For more details or to clarify questions about the scope of the law, you can contact the No Surprises Help Desk at 800-985-3059.
eldiariony.com
Eddie is an Australian news reporter with over 9 years in the industry and has published on Forbes and tech crunch.