Ban On Surprise Medical Bills in Effect

Surprise Medical Bills

Injuries after accidents often require emergency medical treatment. While these treatments are absolutely necessary for someone who has suffered an injury from an accident, stressful medical bills may accumulate as a result. Nearly two-thirds of all bankruptcies filed in the United States are tied to medical expenses and 1 in 5 emergency room visits result in surprise medical bills. These bills typically arise when an insured patient receives care from an out-of-network hospital or provider that they did not choose. Sometimes, a patient may be at an in-network hospital but then receive out-of-network ancillary care during their emergency room visit from providers, such as doctors, radiologists, or laboratories. Common scenarios include an in-network doctor ordering an x-ray and an out-of-network radiologist reading the results, leaving the patient with services that will be billed to them. These unexpected bills put a financial burden on patients, as they are typically expensive, and ultimately lead to significant stress in their daily life.

The Ban

However, starting January 1, 2022, a federal ban on surprise medical bills took effect, meaning that patients who needed emergency care will no longer receive startling medical bills in the mail from out-of-network providers. The new law, ‘No Surprises Act’, was passed by Congress in the final months of 2020, and banned these unexpected bills, adding protection for patients who need emergency medical treatment and/or services at an emergency room. The bill states that consumers cannot be billed for more than the in-network cost-sharing amount as determined by their insurance plan. The rule also bans expensive out-of-network cost-sharing for emergency and non-emergency services, and any coinsurance or deductible must be based on in-network provider rates. The rule that began this month applies to almost every employer-based private health plan, as well as individual policies that were purchased through an exchange within the Affordable Care Act.

 

From this month onward, consumers will now only be responsible for in-network medical bills; however, consumers will need to satisfy their deductible as specified in their insurance plan and will still be responsible for their insurance plan’s co-payments. Patients cannot receive bills from out-of-network providers, including anesthesiologists, pathologists, radiologists, assistant surgeons, laboratories, that may be involved in scheduled services with an in-network doctor and facility. Procedures that fall under this rule are colonoscopies or c-sections, for example. Medicare and Medicaid do not permit a provider to bill patients for a remaining balance of medical treatment or services charges.

Emergency Rooms and Ambulances

While emergency room services will now be billed within the parameters of the bill, ground ambulatory services were not included. Therefore, ambulance companies can charge patients for their services. Eleven states do not allow ambulance companies to bill patients for their services; other states allow the companies to bill patients if an ambulance by road is required. Air ambulance services are in the bill and patients who need an airlift to a hospital will no longer have surprise charges from ambulatory care by air.

Medical bills as a result of accidents that involve a negligent party may be covered according to the at-fault party’s insurance policy limits, such as in the case of a car accident. Other accidents may not have a clear determination about who is at fault and to what extent the injured person is responsible. While the injured person will no longer receive costly out-of-network medical bills, even in-network medical bills can accumulate to an extent, and it is critical to consult an experienced attorney about your case to determine the next steps in the aftermath of an accident.

 

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