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 SeniorsThe 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 patients 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 ActThere are some providers and services that are exempt from the Acts 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 ratesVision-only and dental-only insurances, which are not subject to balance billing protectionsIndemnity plans such as hospital indemnity insurance, which are exempt from the ActIf You Are UninsuredFor 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 ResolutionTo 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 TransparencyIn 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 412-347-1731 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 dont 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 youve 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 session at no charge. Please note this is educational content only and is not intended to act as legal advice.
A newly proposed rule by the Social Security Administration (SSA) could ultimately change the way in-kind income is defined for recipients of Supplemental Security Income (SSI).What Is SSI?Supplemental Security Income (SSI) is a federal public benefits program that provides monthly payments to individuals with limited means, including people with disabilities and seniors. In many cases, recipients of this type of benefit automatically qualify for Medicaid as well.In 2023, the federal SSI payment standard is $914 per month for an individual ($1,371 per month for a couple).SSI Income GuidelinesIndividuals who receive SSI must meet very strict guidelines in order to continue qualifying for these public benefits.For people with disabilities, these guidelines include having an impairment that meets the SSAs narrow definition of disability as well as maintaining specific monthly limits on their assets and income.SSAs Definition of IncomeAs SSI support is intended for those with limited means, any additional income could potentially put an SSI recipients benefits in jeopardy.According to the SSA, income includes any item an individual receives in cash or in-kind that can be used to meet his or her need for food or shelter.An SSI recipient whose income exceeds their monthly SSI award even if it is unintentionally can result in the individual losing their benefits or having them lowered by a certain amount.Historically, SSA has included free food in its definition of income. SSI recipients must provide the SSA with details about their food expenses. A recipient who accepts so-called in-kind support and maintenance (ISM) in the form of food, such as a supply of groceries brought to the recipient by a family member or friend, generally will have their benefits reduced by about one-third.Fortunately for SSI recipients, this is something to which the SSA is now proposing a shift.Proposed RuleIn February 2023, the SSA announced its proposal to omit food from its calculations of ISM. If put into effect, Supplemental Security Income recipients who receive this type of support may no longer see their benefits shrink as a result. In addition, they would no longer need to report their food expenses to the SSA.The complexities of our current food ISM policies may outweigh their utility, the SSA states in its proposed rule. The current requirements for reporting in-kind food receipts could discourage SSI applicants and recipients from receiving an often informal but important form of help.In addition to simplifying reporting requirements for SSI recipients as well as processing time for the SSA, the SSA says the new rule would provide increased financial security to impacted beneficiaries; provide consistent treatment of food support regardless of source; and facilitate improved food security among beneficiaries.The SSA will be seeking public comments on this proposed rule up until April 17, 2023.Additional ResourcesTo learn more about these benefits, refer to this introduction to SSI, or consider consulting with a qualified special needs planner in your area.Contact Sharek Law Office at 412-347-1731 or click here to schedule a complimentary 15-Minute Call to learn how we can help. This article is a service of Sharek Law Office, LLC. We dont 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 youve 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 session at no charge. Please note this is educational content only and is not intended to act as legal advice.
If you're looking to collect life insurance proceeds as the policys beneficiary, the process is fairly simple. However, during the emotional period immediately following a loved ones death, it can feel as if your entire world is falling apart, so its helpful to understand exactly what steps you need to take to access the insurance funds as quickly and easily as possible.Not to mention, if youve been dependent on the person who died for financial support and/or you are responsible for paying for the funeral or other expenses, the need to access insurance money can be downright urgent. Plus, unlike other assets, an estates executor typically isnt involved with collecting life insurance proceeds, since benefits pass directly to a beneficiary, so this is something you will need to handle yourself. With this in mind, weve outlined the typical procedure for claiming and collecting life insurance proceeds, along with discussing how beneficiaries can deal with common hiccups in the process. However, because all life insurance policies are different and some involve more complexities than others, consult with us, your Personal Family Lawyer if you need any support or guidance.Filing A ClaimDeath benefits are not automatically paid out from a life insurance policy. In order to collect the proceeds, you must first file a claim with the life insurance company. But before you start the claims process, you must first identify the beneficiary of the policy: are you the beneficiary, or is the policy set up to be paid to a trust?We often recommend that life insurance proceeds be paid to a trust, not outright to a beneficiary. This way, the life insurance proceeds are protected from lawsuits, creditors, and even a divorce that a beneficiary may be involved with at the time they collect the funds.In the event a trust is the beneficiary, contact us, your Personal Family Lawyer, so we can create a certificate of trust that you (or the trustee, if the trustee is someone other than you) can send to the life insurance company, along with a death certificate, when it becomes available.In any case, you (or the trustee) will notify the insurance company of the policyholders death, either by contacting a local agent or by following the instructions on the insurance companys website. If the policy was provided through an employer, you may need to contact the insureds workplace first, so they can put you in touch with the appropriate insurance representative.Many insurance companies allow you to report the death over the phone or by sending in a simple form and do not require the actual death certificate at this stage. Depending on the cause of death, it can sometimes take weeks for the death certificate to be available, so this simplified reporting option can dramatically speed up the process.From there, the insurance company typically sends the beneficiary more detailed forms to fill out, along with further instructions about how to proceed. Some of the information youre likely to be asked to provide during the claims process include the insureds date of birth, date and place of death, their Social Security number, marital status, address, as well as other personal data.Your states vital records office creates the death certificate, and it will either send the certificate directly to you or route it through your funeral/mortuary provider. Once youve received a certified copy of the death certificate, youll need to send it to the insurance company, along with all of the other forms the insurance company requires you to complete.Multiple BeneficiariesIf more than one adult beneficiary was named, each person should provide his or her own signed and notarized claim form. If any of the primary beneficiaries died before the policyholder, an alternate/contingent beneficiary can claim the proceeds. In that case, however, he or she will need to send in the death certificates of both the policyholder and the primary beneficiary.Minor BeneficiariesAlthough policyholders are free to name anyone as a beneficiary, when minor children are named, it creates serious complications, since insurance companies will not allow a minor to receive life insurance benefits directly until they reach the age of majority, which varies between statesin some its 18, and others its 21.If a minor child is named as a beneficiary, you would need to go to court to be named as the child's legal guardian in order to manage the funds until the child comes of ageand this is the case even if youre the childs natural parent. This is because unless you are specifically named as the guardian of the minors estate, you are not automatically considered the guardian of the childs financial assets, even as their parent. This is why you should never name a minor child as a life insurance beneficiary, even as a backup to the primary beneficiary. Rather than naming a minor as the beneficiary, its often better to set up a trust to receive the proceeds. In that case, the proceeds are paid into the trust, and whomever is named as trustee will collect the insurance proceeds and manage the funds for the childs benefit until he or she comes of age. Moreover, within the terms of the trust, you can also spell out exactly how youd like the trustee to manage the money for the child and even how the child can use the funds once theyve reached adulthood.In any case, you should consult with us, your Personal Family Lawyer to determine the best options for passing on your life insurance benefits and other assets to minor children. Insurance Claim PaymentsProvided you fill out the forms properly and include a certified copy of the death certificate, insurance companies typically pay out life insurance claims fairly quickly. In fact, some claims are paid within one to two weeks of the start of the process, and rarely do claims take more than 60 days to be paid. Most insurance companies will offer you the option to collect the proceeds via a mailed check or transfer the funds electronically directly to your account.Delayed PayoutsThe payout of life insurance proceeds can be delayed for a number of reasons. Beneficiaries often face delays if the policyholder dies within two years of the policy being issued. This is due to the fact that most life insurance policies contain a contestability period. Most contestability periods are typically between one to two years, and if the insured dies during this period, the insurance company can investigate the claim to ensure that the policyholder didnt commit fraud on the policy application by lying about underlying health problems, family medical history, or other conditions.That said, provided the insurance company doesnt discover fraud or other issues with the application, it will most likely pay the claim once the investigation is wrapped up. If problems with the application are discovered, the insurance company might pay a reduced benefit or even deny the claim, depending on what is uncovered.Payout may also be delayed when homicide is determined to be the insureds cause of death and the beneficiary is a suspect. In this case, the payout is typically delayed until the beneficiary is cleared of any involvement in the insureds death. A few other common reasons insurance payouts may be delayed include:The insured committed suicide within two years of the policy being issued.The insured died during the course of illegal or criminal activity, such as a robbery or driving while intoxicated.The insured omitted risky activities, such as smoking or skydiving, on the policy application.Additional InformationSometimes an insurance company will request you to send in a completed W-9 form (Request for Taxpayer Identification Number and Certification) from the IRS in order to process a claim. Most of the time, a W-9 is requested if there is some question or issue with the records, such as having an address provided in a claim form that doesnt match the one on file.That said, a W-9 is simply a way for the insurance company to verify certain information in order to prevent fraud, so dont be alarmed if youre asked for one. This is a common verification practice, and it doesnt automatically mean the company suspects you of fraud or plans to deny your claim.Were Here To HelpWhile collecting life insurance proceeds is often a simple process, dont hesitate to reach out to us if you have questions or need support in any way. As your Personal Family Lawyer, we are here to ensure the process goes as smoothly as possible for you during what is likely to be an extremely trying time. Contact us today to learn more.This article is a service of Sharek Law Office, LLC. We dont 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 youve 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 that was listed on SeniorsBlueBook.com" to find out how to get this $750 session at no charge.