It's hard enough to make it through a medical emergency, but the pain might continue when massive bills arrive despite your insurance coverage. For example, suppose that you underwent emergency surgery for some reason. You scheduled it at a hospital that participated in your insurance network but later received a whopping bill from the anesthesiologist in addition to the surgery bill.
A new federal law called the "No Surprises Act," effective in January of this year, banned "surprise billing" or "balance billing." Before the law passed, specialists like the anesthesiologist in the above example could set their own fees independently of the agreed-to costs between an insurer and a facility within the approved insurance network. Now, specialists' fees will no longer land on patients who receive treatment given by out-of-network specialists at in-network hospitals. Patients must be billed no more than the in-network rate, regardless.
Medicare, Medicaid, and other government programs like Tricare have all forbidden "surprise" billing across the board, whether in an emergency or non-emergency situation. Those patients getting additional bills for independent services should talk to the person at the facility responsible for insurance issues or call 1-800-MEDICARE.
If you need emergency care and are covered by an HMO or private insurance, don't go to an urgent-care clinic if you can avoid it. But if you can't make it to a hospital emergency room, must use a clinic, and feel forced to sign the clinic's form, handwrite on it that you are "signing under duress due to emergency." Take a picture of the form with your note and report the problem to the federal hotline at 800-985-3059. You can also start a payment dispute online at CMS.gov. Your state insurance department may also take appeals.
Even if you end up paying the bill, your complaint will be registered and maybe one day Congress will eliminate the gaps in the "No Surprises Act."
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