Undergoing a comprehensive medical procedure is nothing short of an ordeal. A good deal of preparation goes into planned procedures. Unexpected emergency medical events are even more stressful. Throughout it all, you have to trust that your health care insurance will work the way it is supposed to work.
Even though you have insurance and visit a hospital within your network, you can still receive an unexpected and exorbitant bill. Surprise medical billing is nothing short of distressing, especially after everything you’ve already been through. Surprise medical billing often occurs because the doctor performing your procedure is not in your insurance network, leading to out-of-network charges. Fortunately, consumer protection laws like the No Surprises Act are designed to protect you from these unexpected costs.
How does surprise medical billing happen?
Surprise medical billing occurs when you unknowingly receive services from an out-of-network provider at a network facility. Despite being insured and following all of the necessary steps to stay within your network, you may still face high bills if the doctor or specialist is not part of your insurance plan.
Understanding the protection under the No Surprises Act
The No Surprises Act aims to shield consumers from unexpected medical bills. Under this law, out-of-network doctors working in network facilities are required to accept network rates. This means that if you receive care at a hospital within your insurance network, the doctors there cannot bill you directly for out-of-network charges. However, this protection does not apply if the doctor operates their own office outside of network facilities.
What steps can you take to protect yourself?
There are several steps you can take to protect yourself from surprise medical bills. These steps include:
- Verifying your network: Before undergoing any procedure, confirm that both the facility and all healthcare providers involved are within your insurance network.
- Ask questions: When scheduling appointments, inquire about the network status of all doctors and specialists who will be involved in your care.
- Review your bills: Carefully examine any medical bills you receive. If you notice out-of-network charges, contact your insurance company for clarification.
- Know your rights: Familiarize yourself with the No Surprises Act and other consumer protection laws that apply to medical billing.
By understanding your insurance coverage, asking questions and carefully reviewing your bills, you should be able to get through a medical procedure without unexpected and exorbitant bills. However, mistakes can still happen and even with advance planning, you could still face surprises.
What can you do if you receive a surprise bill?
If you find yourself facing an unexpected medical bill, there are steps you can take to resolve it. These include:
- Contacting your insurer: Reach out to your insurance company to dispute the out-of-network charges. They may be able to negotiate with the provider on your behalf.
- File a complaint: You can lodge a complaint with state regulators or consumer protection agencies if you believe you have been unfairly billed.
In addition, an experienced consumer protection attorney who understands unfair medical billing practices can provide invaluable guidance and advice. A consumer protection attorney can help you understand your rights and assess your situation to see if you have a legal course of action.
Minimize risk, know your rights, stay vigilant
A surprise medical bill is no doubt overwhelming, but understanding your rights under the consumer protection laws and taking proactive steps can help protect you from unexpected financial burdens. By staying informed and vigilant, you can minimize the risk of receiving surprise bills and ensure you are charged fairly for the medical care you receive.