What’s Halloween, without a few creepy, shocking things in the dark?
Who doesn’t like a few chills as they go bump in the night with a bag full of candy?
But unpleasant surprises are the last thing anyone wants when they get sick or hurt.
For years, patients were sometimes broadsided by high costs or hidden services they never anticipated. In some cases, medical bills were astronomical and created severe financial hardship.
Surprise bills can happen with nearly all medical care, but are especially common in emergency care and transport, when women give birth, and for covid hospital care.
Starting next year, you should get no price shocks on your bill. The No Surprises Act covers almost all insurance plans, helps protect the uninsured, and takes effect on January 1, says Dr. Keith Lamy, at Austin family practice diagnostic center.
The new law should help prevent financial ruin for patients. A majority of all bankruptcies filed in the United States are a result of medical expenses. Some of the most expensive services include out-of-network air ambulance trips.
The law ensures patients don’t get walloped by huge bills when they are forced to seek treatment from a provider outside their insurer’s in-network system. In the past, some patients who went outside their network, often during emergencies, later racked up thousands of dollars of debt.
Out-of-network services must be treated as if they were in-network, as far as patient costs. Patients who get treated out-of-network will only pay the same deductibles and copayments as they would under their own insurer’s in-network plan.
The new rule applies to emergency and non-emergency medical care, and also covers expensive air ambulance services.
The only exception is ground ambulance transport, which can be costly. Only a few states provide consumer protections for ambulance bills, so taking an ambulance ride on the ground could still strip your wallet.
The law also prohibits out-of-network charges for ancillary care, such as an anesthesiologist, radiologist, or assistant surgeon, at an in-network facility.
To improve transparency and affordability, the law requires medical facilities to give patients a clear statement explaining their consent is needed before they receive care at higher, out of network cost rates.
When disputes between a doctor and insurer arise over payments, the new rules lay out a process for determining the final cost for all parties, including the patient.
An arbiter will review several factors to decide on the proper rate. The starting point is the median prices that have been negotiated in the area for the same medical service.
For patients who have no insurance, medical providers must provide a good faith estimate of expected charges for scheduled care. The uninsured may also request a cost estimate without scheduling care or services. If the bill turns out to be substantially higher than the estimate, the patient can initiate a payment dispute resolution process.
The hope is that the new law will usher in a more competitive health care system. Using in-network prices and banning hidden charges should ultimately help lower reimbursement rates and reduce inflated medical costs.
The Congressional Budget Office has projected that the new law will reduce private health plan premiums by 0.5%-1% on average, and reduce the Federal deficit by $17 billion over 10 years.
While those estimates have yet to be proven, Dr. Lamy’s practice fully supports the new law as a step in the right direction toward greater transparency, fairness, and affordability within the current American medical system.