I have been hearing over the past several months about a new law that reduces the likelihood that we consumers would get medical bills saying we owed more than our normal co-payment or deductible because a health provider was not part of our insurance plan’s network. The law is called the “No Surprises Act.” It went into effect January 1, but I haven’t had a chance to study it like I would wish.
This morning’s issue of Kaiser Health News (which is a highly-reputable source of information on health policy and the health industry) linked to a podcast where the No Surprises Act was discussed. It’s an 18-minute listen — I scanned the transcript, and pulled out a few key points. Please note that I am not including everything — just some highlights. I’d encourage you to check it out yourself to get the full story.
The No Surprises Act is good news — it is designed to protect us from the extra costs we might incur when an out-of-network provider gets involved in our care, even though our initial contact for care was with an in-network provider. Examples? It could be that our doctor sends our blood samples to an out-of-network lab for testing, or the anesthesiologist our hospital brings in to assist is an out-of-network provider — situations like that.
Of course, nothing is perfect, including this law. There are still things we need to know in order to protect ourselves.
- The No Surprises Bill applies mostly* to hospital care. If you are getting care at a clinic or doctor’s office, you are likely not protected from surprise out-of-network bills. That means you still need to ASK.
*Why did I say mostly? Because there are some urgent care clinics that might be covered, but it is hard to find out. So it’s safer to assume a clinic is not covered. - The law does NOT cover ground ambulance trips, so we may still get big bills for those. (Happily, it does cover air ambulance rides).
- When asking if a provider is in network, the correct question is: “Are you in-network for my insurance plan?” And be sure they know the detailed name of your plan.
Note: the WRONG question to ask is “do you take my insurance?” They might accept your insurance, but still be out of network. - Be cautious if a hospital asks you to sign a “Surprise Billing Protection Form.” The name makes it sound helpful, but you need to read the details. This form is used if the hospital is bringing in a provider who is not in your network. By giving you the form, they are disclosing the out-of-network provider, giving you an estimate of the extra cost you’ll incur, AND telling you the names of in-network providers you could use instead. If you sign the form, you are agreeing to pay the extra charge for an out-of-network provider.
This is a starting point for understanding your rights under the new law. Since it is new, everyone (including providers and insurance companies) will need to be learning new processes and rules. The law creates a hotline for reporting or appealing violations: 800-985-3059. The staff on this line will also be learning, but it’s still wise to report and appeal. Just recognize it may not be a fast or easy process to resolve disputes.
