Surprise medical bills can happen to quite literally anyone, even if you do everything right. You could pick an excellent plan, pay your monthly premiums on time and still get hit with big bills! Although you may choose to visit an in network hospital your ER doctor or anesthesiologist could be out of network. Consequently you could be left with enormous bills. OR, as it is sometimes the case, people are brought unconscious to the closest hospital which turns out to be out of network. Suddenly people with insurance find themselves thousands of dollars in medical debt. Imagine surviving a very scary illness or injury only to be hit with a financially crippling bill. It’s scary and it could happen to literally anyone.
The End of Surprise Medical bills
Although there are many issues which divide party lines, this issue seems to have gained bipartisan support. The surprise billing ban will go into effect January 1st, 2022. It requires out-of-network hospitals and doctors as well as insurers to sort out a fair price for medical care instead of charging patients. The law covers hospitals, doctors and nearly all health care providers. The exception is ground ambulances. So unfortunately there may still be some surprise medical bills there! Still and all, this is a major step forward. There are three main components are this legislation.
Standard Price for Out of Network Care
The federal government is going to define a “fair” price that will play into deciding how much an insurance plan is responsible for. So, you’d be responsible for at least meeting your deductible and copay. Beyond that, the carrier and provider will have to come to an agreement. The insurance carrier and doctor or hospital will go into arbitration if there’s a disagreement. So, you’re out of the middle!
Hospitals and Doctors will have to notify you if they are out of network. Additionally, they’ll have to receive your consent The federal law requires providers to inform patients that they do not participate in their insurance network, in situations that are not a medical emergency. They must gain their consent before treating them or sending a bill. The regulation provides a template for a notice that providers can use to fulfill the requirement. It tells patients:
“If you sign this form, you may pay more because you are giving up your protections under federal law.”
Doctors and hospitals will need to warn patients if any of their care isn’t covered by insurance.
A Complaint System for Surprise Medical Bills
Finally, there will be a complaint system set up to aid you should you feel you’ve been billed in error. It may not be a perfect solution, but it’s a major step in the right direction. It’s one, we hope, will make a big difference in the lives of the average person moving forward. After surviving a scary medical emergency, it’s quite literally adding insult to injury to receive an enormous bill!
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