by Anita Schnee, Attorney at Law
It’s hard enough to make it through a medical emergency. It used to be that the pain might continue, when massive bills started to arrive despite your insurance. Suppose that you underwent emergency surgery for swelling in the brain. This occurred at a hospital that participated in your insurance network, but, later, you received a whopping bill from the anesthesiologist – whom you did not know and did not choose.
This practice, known as “surprise billing” or “balance billing,” is now banned thanks to a new federal law called the “No Surprises Act,” effective in January of this year. Before the law passed, specialists like the anesthesiologist in the above example could set their own fees independently of the fees agreed-to between an insurer and a facility within the approved insurance network. Now, specialists’ fees will no longer land on patients who receive treatment given by out-of-network specialists at in-network hospitals. Patients must be billed no more than the in-network rate.
Medicare, Medicaid, and other government programs like Tricare have all forbidden “surprise” billing across the board, whether in emergency or non-emergency situations. Those patients getting “surprise” bills should talk to the person at the facility who is responsible for insurance issues, or call 1-800-MEDICARE.
Otherwise, the new law has some big advantages for patients, but it also contains serious gaps.
Gap No. One: beware of signing a form headed “Surprise Billing Protection Form.” Signing will give up your rights under the new law, and out-of-network providers will then be free to charge you the higher rates. If you’re asked to sign on an iPad, ask to see the actual form. If it is the so-called “protection” form, don’t sign. Be aware, though, that if you decline, health-care providers can then refuse to treat you. If so, you might need to shop around for another provider.
If you are undergoing non-emergency treatment, you must be provided with this form at least three days before the procedure, or, for same-day service, at least three hours prior. The form should make it clear that out-of-network costs will be more expensive, and that you can avoid that increased cost by choosing in-network doctors who are available to provide the same care at more-economical cost.
Keep in mind that if you have a high deductible on your insurance, it might be an idea to pay cash out of pocket.
Gap No. Two: importantly for our rural neighbors, the law covers extremely expensive air ambulance services, but it does not apply to ground ambulance charges.
Gap No. Three: the new law applies to hospitals. It might not cover lab testing through doctors’ offices, or visits to birthing centers or most urgent care facilities. Ask – using these precise words – “Are you part of my insurance plan’s network?” If you ask, instead, “Do you take my insurance?” the provider could say “yes” – meaning that the provider would submit the bill to your insurer but could still charge you the out-of-network rate.
If you need emergency care and you are covered by HMO or private insurance, don’t go to an urgent-care clinic if you can avoid it. But if you can’t make it to a hospital ER and you must get treated at a clinic, and you feel you have no other choice but to sign the clinic’s form, handwrite on it that you are “signing under duress due to emergency.” Take a picture of the form with your note on it and report the problem to the federal hotline at 800-985-3059. You can also start a payment dispute on-line here.
The Arkansas Insurance Department will also take appeals at 800-852-5494.
Even if you do end up having to pay the bill, your complaint will be registered and maybe one day Congress will eliminate the pitfalls in the “No Surprises Act.”
