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The No Surprise Act: Understanding Your Rights Against Unexpected Medical Bills

Medical emergencies can happen unexpectedly. You could be going about your day when suddenly you feel a throbbing pain in your abdomen. Eventually, the pain travels to the right side of your stomach, slightly below your rib cage. You realize you have a huge problem on your hands because that’s where the appendix is located. The pain continues to become more severe and constant, rendering you unable to do your daily tasks. You have no option but to call someone for assistance. If there’s no one around to help you, you’ll have to call an ambulance to reach the hospital in time.

Appendicitis is one of many medical conditions that can occur unexpectedly. Despite your best efforts, you cannot anticipate some medical bills. For instance, you might have left work at 8 AM, as you usually do, to go to your workplace. En route, you’re rear-ended by another driver. The impact forces your knee to crash against the steering wheel, resulting in a sprained knee. You’ll need to go to the hospital to seek the necessary medical attention. Moreover, you’ll have to take some time off from work.

However, these aren’t the only times when you incur unexpected medical bills. Some medical emergencies and operations require you to get medical attention from an out-of-network facility or provider. In such instances, you might be subjected to balance billing, also commonly called surprise medical bills.

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The good news is that you have certain protections and rights under the 2022 No Surprise Act. If you’ve been subject to surprise medical bills or a healthcare facility or provider has violated these protections, you can take them to court. If you’re looking for legal assistance, www.lawfirm.com can help you find a top-notch legal firm that specializes in medical law.

The No Surprise Act came into effect in 2022 and established new federal protections against unexpected medical bills. It helps both insured and uninsured medical patients understand and plan for healthcare costs and aims to minimize surprise medical expenses.

What are Unexpected Medical Bills?

Unexpected medical bills were a considerable problem for many healthcare receivers before the No Surprises Act came into effect. Even if you had medical insurance but received healthcare from an out-of-network provider or facility, your insurance wouldn’t cover the entire out-of-network expenses. As a result, you would have to pay considerable sums out-of-pocket. The out-of-network facility or provider could charge you the difference between the billed charge and the amount your insurance plan covered unless it was explicitly banned from doing so by state law. This practice was commonly called balance billing. Since most people didn’t anticipate these costs, they also became known as unexpected or surprise medical bills.

While people signed up with Medicare or Medicaid were always protected from surprise billing, those with other insurance plans weren’t. The No Surprise Act aims to rectify this situation.

What Federal Protections Are Provided to Insured Medical Care Recipients?

The No Surprise Act provides several federal protections to people with health insurance plans from their employers, a Health Insurance Marketplace, or an individual healthcare plan from a reputable insurance company. Some of the protections include:

  • The No Surprise Act bans surprise bills for most emergency services, even if you received them from an out-of-network provider or facility. Similarly, you cannot receive unexpected medical expenses for services received without prior authorization.
  • The Act also prohibits out-of-network cost sharing for nearly all emergency and some non-emergency services. Therefore, medical care recipients cannot be charged more than in-network costs for such services.
  • The No Surprise Act also prohibits out-of-network costs and balance bills for certain services, such as radiology or anesthesiology, provided by out-of-network facilities or providers when a patient visits an in-network facility.
  • It also requires healthcare providers to give notices to patients. These notices must be easily understandable and explain applicable federal billing protections. In addition, these notices must also provide contact information for patients if a provider or facility hasn’t adhered to The No Surprise Act’s regulations. Furthermore, these notices also require patient consent if certain billing protections are waived.
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What If You Don’t Have Medical Insurance?

Research shows that approximately 8.4 percent of Americans didn’t have health insurance in 2022. If you don’t have medical insurance and pay for healthcare bills out-of-pocket, you’ll be delighted to know that The No Surprise Act also provides you with some protections. As per the Act, healthcare facilities and providers are legally required to give you a good faith estimate detailing how much your medical care will cost before you receive it.

It’s important to note that you’re only eligible to receive a good faith estimate if you schedule healthcare services a few business days in advance. Healthcare providers and facilities aren’t required to give you an estimate when providing emergency services.

A good faith estimate will include your overall estimated bill, accounting for various healthcare services and items, such as facilities and hospital expenses.

What Happens If You Are Charged More than Your Good Faith Estimate?

It’s important to note that the No Surprises Act allows you to dispute medical bills if they’re considerably higher than the good faith estimate you received. Any services provided in 2022 with final charges of $400 or more than the good faith estimate can be disputed within 120 days.

What If Your State Has a Surprise Billing Law?

An important factor to consider is that the No Surprises Act doesn’t replace state surprise billing laws. It only supplements them. If your state has a surprise billing law, the Act will protect you by creating a floor for protection from unexpected medical bills from out-of-network facilities and providers.

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If your state already has a surprise billing law that meets the Health and Human Services (HHS) minimum requirements and operates its own resolution process for patient-provider disputes, then the HHS will not intervene. Instead, it will defer to the state’s judgment and process.

Conclusion

We can not deny that the American healthcare system has numerous flaws that could be improved since they favor healthcare providers and facilities instead of healthcare recipients. The No Surprise Act aims to rectify the situation by protecting consumer rights federally, saving customers from having to pay out-of-pocket for services from out-of-network providers and facilities.

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