Medical bills can continue to surprise consumers despite the No Surprises Act.
Earlier this year, President Joseph R. Biden commented that “millions of working Americans will no longer have to worry about unexpected medical bills.” He was referring to the federal. Law without surpriseswhich entered into force in 2022 and provides protections for consumers against unexpected medical bills.
But if President Biden’s statement will have hold true it is Complicated by loopholes in the law and administrative regulations, as well as a recent federal court decision and legal challenges.
People living in the United States to worry more on surprise medical bills than on other home and health care costs. And in the last two years, a third of insured adults reported receive a surprise medical bill. To address this systemic problem, the US Congress. enacted the No Surprises Act in late 2020 to address surprise medical bills and provide patient protection.
Law without surprises Attempts to eliminate unexpected medical bills by requiring private health plans to cover surprise medical bills at in-network rates. If an insured patient receives a bill for emergency services, air ambulance services, or care provided by an out-of-network provider at an in-network hospital or facility, patients are only responsible for what they would have been charged for receiving in-network services .
The law also forbids Balance-of-care billing by out-of-network providers for emergency services, in-network hospital services, and certain non-emergency services, which means that patients only pay the in-network cost-sharing amount net. legislators tried so that when a patient receives a surprise medical bill, the insurance company and health care provider agree to pay through arbitration, rather than burdening the patient with the task of fighting the fee.
Although these protections have been hailed as an important first step, some experts are already pointing out to the limited coverage of the law and many loopholes. For example, the Act’s protections only Apply to hospitals If a surprise bill comes from from a doctor’s office, a birthing center, or most urgent care clinics, the patient may still have to pay.
A surprise bill could also appear if a patient’s doctor orders a test from a lab that is outside the patient’s insurance network. According to the Law, the laboratory does not have to theme a warning that the patient is being tested by an out-of-network provider.
Ground ambulances are another place where the Law cannot to protect patients if a patient goes to the hospital by air ambulance, they are protected, but if the patient goes to the hospital by ground ambulance, the patient can get stuck with a large medical bill. To avoid a surprise medical bill, patients’ best bet might be abstain from treatment in a ground ambulance, but that could only delay crucial care until after they have reached a hospital by other means of transport.
Once patients are admitted to a hospital, they receive some protections, such as those provided by the Surprise Billing Protection Form. If a patient is receiving care in a hospital and a provider recommends the patient sees another provider, the first provider must inform the patient if the new provider is outside the patient’s insurance network. Also, surprise billing protection form requires Providers to estimate the cost of seeing new providers and list possible in-network providers who can provide the same service.
Patients may encounter a major problem with the surprise billing protection form. Although the provider must provide a good faith estimate of the cost of the out-of-network provider, the Surprise Billing Protection Form also it serves as resignation. after a patient signs the form, the full protections of the No Surprises Act no longer apply.
Due to the renouncing function of the form, the Law forbids certain types of providers (emergency room physicians, attending surgeons, anesthesiologists, and radiologists) ask patients to sign the form. If one of these types of providers tries to get a patient to sign the protection form, the patient may to call a federal hotline designed to receive reports of violations of the No Surprises Act. After reporting a possible violation to the hotline, the provider cannot report the debt to a collection agency while hotline employees or other workers conduct an investigation.
And patients who don’t have health insurance, or who don’t want to use it, also have greater protections under the Act. requires any provider to provide a good faith estimate of what they expect to charge the patient. If the actual bill is more than $400 more than the good faith estimate, the patient pay the good faith estimate plus an additional $400, and the provider cannot collect the rest of the bill.
Despite the gaps, some experts and interest groups have praised The No Surprises Law. But some medical providers are less enthusiastic. In the last two years, many providers have initiated lawsuits challenging the arbitration process established by the US Department of Health and Human Services. These suits have had some success. In a victory for medical providers, a district court recently tipped over some aspects of the Law related to the independent dispute resolution process.
Although the Act is in jeopardy due to legal challenges, affected patients, providers and insurers are still beginning to understand the protections of the Act and its limitations.