There Is A Ban On ‘Surprise’ Medical Bills Starting Next Week And We Are Here For It

If you’ve been to the Emergency Room in the past, you might have noticed that you usually receive a nasty little “surprise” medical bill in the mail that you didn’t expect — like those from doctors who are sometimes outside of your insurance’s network.

There’s nothing like being sick enough to need an ER, and then be saddled with all this debt that you probably weren’t expecting. Ugh, right?

Well, as of January 1st, all that is changing thanks to a law that was “passed during the Trump administration and fine-tuned by the Biden administration” that addresses these “surprise” doctor bills.

It has taken two years to settle, but this bill means that hospitals and doctors will be required to work with all insurers to work on settling payments.

I think this is so pro-consumer, it’s so pro-patient — and its effect will eventually be felt by literally everybody who interacts with a health care system.

Senator Bill Cassidy

These bills are oftentimes completely unfair*, and involve a lot of time and often more burden than should be necessary to clear up and settle.

Even for those who HAVE insurance, a trip to the emergency room is still hella expensive. And, if you have a high deductible with your insurance carrier — like me — these visits can be CRAZY expensive.

I have an existing medical problem, and I have to visit the ER at least once a year — but, I always debate whether I should really go, because I know it is going to put us in a HUGE financial hole. Those bills add up, man!

There is absolutely no reason*, if you really need to go to the Emergency Room, the thought of owing a ton of money should prevent you from getting the care you need.

The compromise would take patients and their families out of the financial crosshairs by limiting what they can be billed for out-of-network services to a fee that’s based on in-network charges. The amount consumers pay would get counted toward their in-network annual deductible.

The Christian Science Monitor

This new bill is SUCH good news for so many Americans — ESPECIALLY with so many people needing to go to the ER with all these COVID-related situations!

If you are having a medical emergency and go to an urgent care center or emergency room, you can’t be charged more than the cost sharing you are accustomed to for in-network services. This is where the law’s protections are the simplest and the most clear for people with health insurance.

The New York Times

Now, you will still be required to meet deductibles and make your co-payments, but that should be the extent of what you should be expected to be billed for.

That’s awesome, right?!?

According to The Christian Science Monitor, there are a few key things that this new bill will do.

• It will hold patients “harmless from surprise bills stemming from emergency medical care. This applies if the patient is seen at an out-of-network facility, or if they are treated by an out-of-network clinician at an in-network hospital (happens all the time). In either case, the patient could only be billed based on their plan’s in-network rate.”

• It protects “patients admitted to an in-network hospital for a planned procedure when an out-of-network clinician needs to get involved with the case. This can happen when a surgeon is called in to assist in the operating room (which happens more than you might think), or if the anesthesiologist on duty is not part of the patient’s plan.”

• It will “generally require out-of-network service providers to give patients 72-hour notice of their estimated charges. Patients would have to AGREE to receive out-of-network care for the hospital or doctor to then bill them.”

• It bars “air ambulance services from sending patients surprise bills for more than the in-network cost sharing amount. — HOWEVER, ground ambulance services will not face the same restrictions, and the legislation only calls for more study of their billing practices.”

We shouldn’t have to depend on people knowing minutia about insurance regulation in order for them to get care or not be unfairly billed,

Anthony Wright, the executive director of Health Access California

So, bring on the New Year with open arms! We will no longer have to be subjected to “surprise” bills when we need emergency care!

*My opinion