No Surprises Act Prevents Medical Bill Surprises

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Nobody enjoys getting a bill, but it's twice as unwelcome to get a bill you weren't anticipating. Most Americans either have experienced receiving a surprise medical bill themselves or know someone who has. A recent survey found that an average of 18% of ER visits result in at least one unexpected bill. But there is some relief: Congress passed the No Surprises Act that went into effect on January 1, 2022 to specifically prevent these kinds of unwanted surprises. Laws regarding surprise medical bills - particularly new ones, like the No Surprises Act - can be confusing and tricky to navigate, particularly if you have recently received an unexpected medical bill. Our network of dedicated, experienced attorneys can walk you through the consumer protections of the No Surprises Act and what to do if you get a surprise medical bill. Learn more about our legal protection plans and read on for an overview of the No Surprises Act.

The New Rules of the No Surprises Act

• The Act bans surprise bills stemming from emergency care - such as treatment in an ER, ambulances, or when you are unknowingly treated at an in-network facility but by an out-of-network physician - and requires that co-pays and other cost sharing be determined by in-network rates.

• The Act prohibits unexpected billing from out-of-network providers if you go to an in-network hospital for care, and any cost sharing from those visits will be determined from in-network rates.

• The Act requires that facilities and providers send straightforward notices that explain all applicable billing, protections, and contact information.

Consumer Protections for Uninsured Patients

Uninsured patients are considered self-paying and must cover all bills out-of-pocket. The No Surprises Act protects uninsured patients by requiring providers to give a "good faith estimate" of total costs before giving you non-emergency care. This estimate must include projected costs for treatment as well as any expected additional costs. If the final bill you receive exceeds the good faith estimate by more than $400, you have the right to challenge the charges.

Your State May Provide Additional Protections

More than 30 states have introduced safeguards against surprise medical billing, but only 17 are considered comprehensive. These 17 states offer extended protections that cover in-network emergency situations, but they only apply to certain types of insurance and in specific scenarios.

While Federal laws cover most insurance plans, some state law provisions may differ from Federal law, and in those cases, Federal laws defer to the states.

If you have questions about a medical bill you received or want to find out if the No Surprises Act can help you with a medical bill, you can contact your attorney through our network of lawyers using your subscription to our legal protection plans any time of the day or night, 24/7 using our app or by telephone. And at just $29.95 per month, it pays for itself the very first time you use it. Your attorney can give you advice on the consumer protections as they relate to your specific situation, including your insurance, your state law, and even write letters or make phone calls on your behalf. Learn more about all the benefits of membership in our legal subscription plans or sign up now!

Medical Billing Errors & Mistakes - What You Need To Know

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Some real talk: medical costs in the United States can be expensive and complicated, and getting through a difficult healthcare system that includes co-pays, insurance, and possibly Medicare or Medicaid regulations is, very often, confusing, at best. But what happens if you get an erroneous bill, such as a bill that isn't yours or a bill that is much more than you anticipated? Sorting through a surprise or incorrect medical bill can be stressful and confusing, but members of our legal subscription plans have legal help at their fingertips when situations like these occur. The first thing you should do is to keep all documents, quotes, and bills together for easy reference by you or your attorney. Read on for a few more tips.

Billing Mistake or Fraud?

One of the surprising things that can happen in cases of identity theft is medical billing fraud. Here's how you can tell the difference between medical billing mistakes and medical billing fraud:

Are the billed services for treatments you actually received but on a different date? This is an example of a billing error. If you receive a bill for treatments, services, or visits but you do not remember those treatments, or the services are on the wrong date or the wrong location, or are for far more than what you were told you would pay, it may be some form of fraud scheme and you should contact your attorney right away. Sometimes, scammers sell or use stolen identity documents, and those credentials are used by someone other than yourself to procure medical services while you get the bill. In cases like these, you should definitely contact your lawyer as soon as possible, as well as credit reporting agencies. We also offer identity theft services that can protect you.

Contesting A Bill

In emergencies, it is easy to overlook things at admission, but if you don't recall something that appears on a medical bill, the first thing you should do is gather relevant documents and insurance information and review those documents. If you are missing documents, it is likely that the documentation is stored electronically, and you should be able to request copies of your medical records from the facility.

Next, contact your insurance company to see if they covered the correct amount. There may have been a mistake concerning a billing code, or incomplete or incorrect information was sent to the insurance company. This happens more frequently than you might think! Next, reach out to the medical provider's billing department for an explanation and to correct any mistakes. Make sure to take notes of your conversations with billing personnel, including the name and title of the person(s) you spoke to. Follow up with an email to the person you talked to so there is a record of what you talked about and any misunderstandings can be cleared up in writing. Some facilities use an online chat and you can download those conversations for your records.

After contacting your insurance company and the medical provider's billing office, you can go over your options. You can work out a payment plan with the provider, or you can dispute the bill. If you choose to dispute the bill, your attorney will be an invaluable resource. Often, lawyers are able to get results most of us just can't get, and the resolution is often cleared up in less time.

Legal Options

Your attorney through our legal subscription plan can help you in many ways:

• Review your documents and give advice

• Make calls or write letters on your behalf

• Assist with dispute resolution through mediation or arbitration, depending on your situation

Do not ignore incorrect billing statements or demands for payment, regardless of the situation. Medical bills get sent to collections all the time and may impact your credit.

Receiving an enormous, incorrect, or even fraudulent bill from a medical provider can cause a lot of stress and anxiety, but members of our legal subscription plans can get access to dedicated, experienced attorneys familiar with insurance companies and medical billing to help. Our plans start at just $29.95 per month and pay for themselves the first time you use them. Work with a medical billing lawyer quickly and easily and get answers to questions and concerns, have phone consultations, get documents reviewed and explained, and much more. Learn more about all the benefits of membership or sign up today!