An Easy-to-Use New Federal Law Can Help Prevent Unexpected Medical Bills at the Door.


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For private insurance consumers, out-of-network providers may no longer charge for treatments not covered by their plan. On January 1, the federal No Surprises Act became law.

Before the Affordable Care Act, many patients who sought non-emergency medical attention from a doctor or facility outside their insurance network and who were not in their network were hit with unanticipated medical bills. Premature receipt of medical bills made it difficult for patients to do any research on their providers. Before surgery, even if your primary surgeon is on the list of participating providers, you may be treated by a non-participating anesthesiologist.

On the other hand, these bills are likely to be forgotten about shortly.

Medical treatment must be provided without prior permission. Whether or not a physician or facility is in a network, according to the US Centers for Medicare & Medicaid Services, which states on its website that “Excessive out-of-pocket payments” would be limited.

Although numerous states have similar laws, this is the first federal action to address the problem of unexpected expenses.

If you need to be evacuated for medical treatment, you won’t have to worry about unforeseen expenses because of the No Surprises Act. Ground ambulance services are exempt from the No Surprises Act. If an ambulance is needed, you may be forced to pay for it out of your pocket.

But this should not influence the ban on unexpected expenditures, as medical providers are suing. According to the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy.)

Unexpected medical costs: How often are they?

In the past, it was common to be hit with an unexpected bill from an out-of-network provider after receiving emergency care, and according to the Kaiser Family Foundation, one out of every five emergency claims and one out of every six network hospitalizations for privately insured individuals in 2021 included an out of network fee.

According to the group, two-thirds of people are worried about unplanned medical costs, which may reach hundreds or even thousands of dollars.

What should you do if you were hit with an unexpected medical bill?

Out-of-network doctors used to charge people directly for their services. Afterward, the patient would have to submit an out-of-network claim to their insurance company and hope for the best.

It is the responsibility of the health insurance plan to alert the doctor or hospital when a bill is received from a provider who is not in their network. The patient will then get a written explanation of benefits from the health insurance company. The provider will receive a first payment (a statement explaining what was covered and what the patient owes the out-of-network provider).

Patients may only be charged by an out-of-network practitioner when all of this has been completed. According to the Kaiser Family Foundation, the amount you would have paid if the providers had accepted your insurance.

You should seek a revised bill if an out-of-network provider charges you more than what’s shown on your explanation of benefits, advises the Center on Health Insurance Reforms. You may call or email the government “No Surprises Help Desk if it doesn’t work.”

Even though federal law bans surprise billing, patients are still responsible for any in-network charges, which may be difficult to discern. Medical costs, prescription drugs, and more may all be slashed with Money’s guide to saving money.


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