On January 1, 2022, a new rule took effect that will help insured patients when it comes to emergency healthcare services and uninsured individuals and families when it comes to non-emergency healthcare planning. The No Surprises Act protects us all from surprise medical billing. Along with protection from surprise billing, people now have a place to turn for help in understanding their medical bills, especially when surprise billing is suspected.
Insured Patients Get Relief from Out-of-Network Expenses after Emergency Care Services
From research and review by the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE), the identification of “surprise billing is common among those with private insurance—nearly one in five patients who go to the emergency room, have an elective surgery, or give birth in a hospital receive surprise bills, with average costs ranging from $750 to $2,600 per episode.”
In emergencies, there is usually no time to determine where patients can or cannot be treated. Insured patients no longer have to worry about getting hit with the balance billing from out-of-network providers, “even when care is received without prior authorization.” Providers and payers must now work together to determine the appropriate charges while taking into consideration the importance of quality patient care.
Along with quality care being first and foremost, providers and facilities must also provide “easy-to-understand notices that explain the applicable billing protections and who to contact if they have concerns that a provider or facility has violated the new surprise billing protections.”
Self-Pay Patients Get Better Price Transparency of Non-Emergency Care Services
Uninsured (self-pay) patients also have the right to emergency care, as long as they “meet the federal guidelines of what constitutes an emergency situation.” As for non-emergency care, self-pay patients should now receive an estimate of costs before any medical care or procedures take place.
“The good faith estimate must include expected charges for the primary item or service, as well as any other items or services that would reasonably be expected. For an uninsured or self-pay consumer getting surgery, for example, the estimate would include the cost of the surgery, as well as any labs, other tests, and anesthesia that might be used during the procedure.” When the charges exceed the estimates “by $400 or more,” the patient has the right to question and dispute the final charges through an arbitration process to help with price negotiations.
Be In Control of Your Medical Bills to Avoid Long-Lasting Financial Implications
For some patients, medical care is critical to maintaining their quality of life. Whether insured or self-pay, it’s important to understand why and how patients should tackle any medical debt before long-lasting financial problems arise. Whether it’s a co-pay, patient responsibility to reach the deductible, or self-pay amount, don’t allow these debts to go into collections that can affect credit ratings. It’s better to address medical bills as soon as possible. When necessary, set up a payment plan.
As the No Surprises Act now addresses “balance billing” of emergency services from out-of-network providers, insured patients are also protected from balance billing of any services when the provider is in-network with the patient’s insurance. Even if a medical charge is incorrectly charged, any “balance owed by the patient” should never be ignored to avoid collection agency involvement.
Whenever patients have questions about healthcare billing, there is a place to go for help and guidance. “Both insured and uninsured/self-pay individuals who are concerned that their rights have been violated now have access to a host of tools, including a help desk (available at 800-985-3059, 8am-8pm ET seven days a week; TTY: 800-985-3059) and webpage (CMS.gov/nosurprises), where more details on registering potential violations can be found.”
Health insurance shopping can be confusing and frustrating. When you’re in the market for insurance choices, Healthcare Solutions Team (HST) is here to help you connect with the industry’s top agents who will help you find the coverage that is right for you and your budget. From individual and family to group plans, we can help you with medical, dental, senior products, and more.