Clients feel pressured by sudden medical bills, even by law | So Good News

By John Rossheim | NerdWallet

The No Surprises Act, known as the No Surprises Act, called protection for patients from unexpected medical bills, went into effect on New Year’s Day 2022. pay” for the share of charges that are not covered by insurance?

Recent reports of the new law have been mixed.

Health insurers report the number of extraordinary bills that the law prohibits but complain about the number of financial disputes.

Researchers believe the law was written to provide more protection for consumers, but they have not yet seen enough data to judge compliance.

Health care users give it a low grade, according to a June survey by Morning Consult. One in five respondents said they received an unexpected medical bill in the first half of the year, the survey found. But it’s unclear how many of those surprises — if any — would have been covered by the limited protections of the No Surprises Act.

“It’s hard to know if the law is being enforced because the question is: Are consumers not getting a windfall?

An expert on soil

Patricia Kelmar | Director of Health Care campaigns at US PIRG

The law prevented more than 2 million potential shocks from reaching insured patients as of Jan. 1 to February, according to AHIP, the insurance trade group. But experts are still skeptical.

“It is difficult to know if this law is being used because the issue is: They are consumers no getting windfalls,” says Patricia Kelmar, director of health care campaigns at the US Public Interest Research Groups, a national association of consumer advocacy organizations.

Adding to the skepticism of observers about the effectiveness of the law is reducing consumer awareness of the new protection. In June, only 16% of adults said they had seen, read or heard something about the No Surprises Act, according to a Morning Consult survey. Consumers who do not know the law are also unaware of their rights if providers and insurers fail to comply.

The complexity of the law – especially in the form of exceptions that allow offline payments and charging fees in some cases – raises some questions. “Not everything that patients think is a problem falls under the NSA,” said Loren Adler, executive director of the University of Southern California-Brookings Schaeffer Initiative for Health Policy. Urgent care, for example, does not receive legal protection over emergency care.

Does the new law work?

It may be too early to tell how the new consumer protections are working, and government agencies are not releasing statistics. The Centers for Medicare & Medicaid Services, or CMS, and the Department of Health and Human Services did not respond to a request for data on consumer complaints about violations of the No Surprises Act.

“It’s hard to know, but I find mistakes happen from time to time,” said Karen Pollitz, senior partner and director of KFF’s Patient and Consumer Protection Program, health affairs and policy. organization. “If something goes wrong, it falls to the consumer to figure out what to do, and that’s not how it should be.”

Some observers are satisfied with how the law works. “The No Surprises Act is working well,” says Adler. “It’s not going to fix any of the medical issues, and there are a few things that are left with a surprise refund.”

How the law is supposed to protect you

The No Surprises Act’s protections are most extensive in the emergency room, where patients are at greater risk and have little control if all of their doctors are in the insurance network.

Pollitz said: “A lot of amazing medical issues are going to involve emergency services.” “In the ER, it’s no different. Anyone who touches you or takes pictures of you has to submit a claim to your health plan first – before they send you a bill – so they can determine your co-pay. If they don’t, they pay $10,000 each time they do something bad. “

Hospitals are also prohibited from paying for post-hospital care, services provided by any department after a patient receives emergency care.

The new law also protects out-of-network reimbursement and emergency care coverage, but with various exceptions. For example, if your in-network doctor orders a test from an out-of-network lab, the lab may still bill you for the difference between in-network and out-of-network prices.

The No Surprises Act provides various consumer protections if you do not use insurance. “If you’re paying out of pocket or don’t have insurance, you have the right to get a good faith estimate in advance,” says Kelmar. “This gives consumers the opportunity to step back and plan for their health care.”

If you have been asked to sign a waiver of your rights under the No Surprises Act, think before you agree to what may be financial limitations. If you sign and later regret it, you can still take action. Providers are not allowed to ask patients to withdraw coverage if there is no online provider, if there are unexpected medical needs or additional services.

What to do if you receive an unexpected bill

What do you do with an internet price that is greater than your internet plan? You may need help to find out what is causing the charge. “This could be a mistake, or it could be donors who are still trying to make a profit by sending money,” says Kelmar.

You can try calling CMS’s No Surprises Help Desk at 800-985-3059; the application will tell you how to file a dispute or complaint in each state. Support is available in English and other languages. “CMS needs to know who can handle any complaints,” says Pollitz.

It is important to note that CMS has two options for buyers who do not agree with the delivery fee:

• If you’re using health insurance and believe you’re being billed more than the online rate for doctors or services covered by the No Surprises Act, you can file a complaint.
• If you don’t have insurance or choose not to use your insurance and the provider is paying more than $400 for the estimate, you can dispute the bill.

Under the No Surprises Act, your state has chosen one way to encourage:

• Some countries set their own laws.
• Some states stop enforcing federal agencies.
• Some states also cooperate with federal agencies in enforcement.

The No Surprises Help Desk should tell you how enforcement works in your area.

Adler offers a different starting point: “If you get an unexpected bill from a provider, your first resort is your insurance; they are at risk of having their license revoked if they do not follow the rules.”

Pollitz suggests another option: State Consumer Assistance Programs, or other federal or state agencies that provide assistance to consumers with insurance issues. “Customers should reach out to anyone they think can help them,” he says.

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John Rossheim writes for NerdWallet. Email: [email protected].