How No Surprises Act May Help With Unexpected Medical Bills
Entrusted Legacy Law
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Aug 21, 2023
Pennsylvania - Greater Pittsburgh Area
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The No Surprises Act is a federal law enacted to
protect patients from unexpected medical bills incurred on or after January 1,
2022. It aims to address the issue of surprise medical billing, which can occur
when patients receive unexpected charges for their medical care. The Act
applies to out-of-network emergency services, out-of-network air ambulance
services, and certain out-of-network care received at in-network facilities.
Help for Seniors
The Act is important for all patients, but especially for
seniors. Seniors are especially vulnerable to surprise medical billing because
they often need more health care than other populations. They are more likely
to be seen by out-of-network providers. The Act protects them from unexpected
charges and provides a much-needed safeguard for their medical expenses.
Under the Act, patients are not responsible for surprise
medical bills beyond their in-network cost-sharing amount. This means that
patients will only be responsible for paying the same amount they would have
paid if an in-network provider provided the care. The Act also prohibits
balance billing, which is when providers bill patients for the difference
between their charges and the amount paid by the patient’s insurance.
This can be relevant in a variety of settings seniors
encounter, including emergency room visits, second opinions, surgical
procedures, and even skilled nursing care where independent contractors provide
services. Under the Act, providers must accept the Medicare-approved amount as
payment in full. This prevents patients from being surprised with large
balances and protects them from unexpected financial hardship.
Exceptions to the Act
There are some providers and services that are exempt from
the Act’s billing protections (although your state may have a similar law that
does not exempt them). These include:
- Ground
ambulance services, which can charge you out-of-network rates
- Vision-only
and dental-only insurances, which are not subject to balance billing
protections
- Indemnity
plans such as hospital indemnity insurance, which are exempt from the Act
If You Are Uninsured
For uninsured or self-paying patients, the No Surprises Act
provides rules for a good faith estimate of how much a medical service will
cost. You may request an estimate if you schedule a medical service at least
three business days out or simply ask for one. If your final bill is $400 or
more than the estimate, you may be able to dispute it. Having a good faith
estimate allows patients to make informed decisions about their care.
Independent Dispute Resolution
To resolve payment disputes between providers and insurers,
the Act establishes an independent dispute resolution (IDR) process. This
process allows providers and insurers to submit their proposed payment amounts
to an independent arbiter who makes the final decision. The IDR process aims to
protect patients from being caught in payment disputes and ensures a fair
resolution for all parties involved.
Pricing Transparency
In addition to protecting patients from surprise medical
bills, the Act also includes provisions to increase health care pricing
transparency. Health insurers must provide patients with clear and detailed
information about their health care coverage. This includes a description of
providers’ network status and estimated cost-sharing amounts. This increased
transparency aims to empower patients to make informed health care decisions
and avoid unexpected charges.
The No Surprises Act is a significant step toward addressing
surprise medical billing and protecting patients from financial harm. By
implementing clear rules and procedures, patients are not caught off guard by
unexpected charges and have access to fair dispute resolution. With the Act in
place, patients can have more confidence in seeking medical care, knowing they
will not face unexpected financial burdens.
Contact Sharek Law Office at 412-547-9855 or click here to schedule a complimentary 15-Minute Call to see how we can help you.
This article is a service of Sharek Law Office, LLC. We don’t just draft documents; we ensure you make informed and empowered decisions about life and death, for yourself and the people you love. That’s why we offer a Life and Legacy Planning Session, during which you will get more financially organized than you’ve ever been before and make all the best choices for the people you love. You can begin by calling our office today to schedule a Life and Legacy Planning Session and mention this article to find out how to get this $750
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- Seniors Blue Book was not involved in the creation of this content.
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