Denis Doulgeropoulos
Your Financial Professional & Insurance Agent
What a Relief! Congress Acts Against Surprise Medical Bills
If you have ever been caught off-guard by a large medical bill, a long-running practice known as balance billing might be the reason. A balance bill — which is the difference between an out-of-network provider’s normal charges for a service and a lower rate reimbursed by insurance — can amount to thousands of dollars.
Many consumers know that in-network providers usually cost less. However, emergencies often limit your ability to choose providers. Furthermore, some hospitals and urgent-care centers use physicians, labs, or ambulance services outside your insurance network. As a result, patients may receive unexpected charges. In fact, a recent survey revealed that 18% of emergency room visits led to at least one surprise bill.1
Comprehensive Protection Under the No Surprises Act
The federal government included the No Surprises Act in the omnibus spending bill passed in late 2020. Consequently, the law protects patients from unexpected medical bills. Starting in 2022, patients no longer receive balance bills for emergency care. In addition, patients avoid surprise charges when out-of-network providers treat them at in-network hospitals without their knowledge. Previously, some states offered similar protections. However, the new federal law provides broader and more consistent coverage nationwide.
Under the new rules, patients pay only their standard in-network deductibles and copayments. Meanwhile, providers and insurers negotiate payment directly. If disagreements arise, they resolve disputes through arbitration. Furthermore, these protections apply to doctors, hospitals, and air ambulance services. However, ground ambulance services do not fall under this law.
Consent Requirements for Out-of-Network Care
Some patients intentionally choose out-of-network providers. For example, they may prefer a trusted physician or specialist. In these cases, providers may still charge balance bills. However, they must first provide a good-faith cost estimate. Additionally, patients must sign a consent form at least 72 hours before treatment. Therefore, patients gain transparency and control over their health-care expenses.
Certain specialists cannot request consent for balance billing. These include anesthesiologists, radiologists, pathologists, neonatologists, assistant surgeons, and laboratories. Consequently, patients receive additional protection in situations where they cannot reasonably choose their providers.
Concerns About Rising Health-Care Costs
Most adults worry about their ability to afford health-care costs. Furthermore, rising medical expenses create financial stress for many families. Consequently, laws like the No Surprises Act help reduce financial uncertainty. As a result, patients can focus on receiving proper care without fearing unexpected medical bills.
Big Bills Will Keep Coming
Millions of consumers will benefit from protection against surprise medical bills. However, many individuals still struggle to pay out-of-pocket health-care expenses. For example, uninsured patients face full medical costs without coverage support. Additionally, insured individuals often deal with high deductibles and rising premiums. In 2020, covered workers with family plans paid an average of $5,588 toward premiums. Furthermore, deductibles ranged from $2,700 to more than $4,500, depending on the plan type.2
When planning nonemergency surgery or expensive treatment, you should carefully compare providers and facilities. Prices often vary significantly between doctors and hospitals. Therefore, request detailed cost estimates before making a decision. Additionally, you can negotiate better pricing and reduce your overall expenses. Taking these steps helps you manage health-care costs more effectively.
If you receive a higher-than-expected medical bill, review it carefully. First, check for billing errors or incorrect charges. Next, verify billing codes and confirm insurance coverage. If you identify mistakes, contact the provider and dispute the charges. Furthermore, you can negotiate a discounted settlement if needed. As a result, proactive communication may help reduce your financial burden.