(AscendHealthy.com) – The last thing you want to see after a major medical event is an exorbitant bill. Unfortunately, this is a common occurrence for many Americans: emergency surgery with an out-of-network anesthesiologist, ambulance transport from an out-of-network provider, and many other emergency services and rooms can cost thousands. After all, insurance companies don’t care if you have an emergency or don’t know if your providers are covered. If you use an out-of-network provider, you’ll have to pay… even if you are unconscious or otherwise cannot consent.
Many people are tempted to do everything they can to avoid high medical bills, but they are many are desperate to pay off their high bills to avoid a hit to their credit. However, the No Surprises Act can result in paying little or nothing on the bill if you have active insurance, even if you are taken to an out-of-network provider.
What Is the No Surprises Act?
Starting in January 2022, the No Surprises Act makes it impossible for out-of-network providers to force Americans to pay these large fees for emergency situations. Sometimes, patients are admitted to out-of-network hospitals or medical centers, resulting in higher costs for each specialist visit and each hospital and medical event.
It sounds like your insurance company is waiting for you or someone else to call 911 in an emergency to verify that you go to the hospital and call your insurance company and check with all the doctors. Some insurance companies also charge high fees because these services are not authorized. In non-urgent situations, images such as MRI or CT scans take time to go through the insurance approval process, but not in emergency cases.
How to Dispute a Bill Under the No Compliance Act
Insurance companies are in the business of making a profit – remember that. Your initial dispute must be addressed directly to the insurance company in writing. Remember to cite the No Surprises Act. You may go through one or two rounds of appeal (or review) with the insurance company, where they may agree to pay more than the bill or reject it altogether.
If they deny everything, it’s time to take the case directly to your local Congressman (one who generally favors health care and policies that benefit citizens and businesses). They will support or contact you with legal assistance to pursue these bills.
Ground Transport (Local Ambulance Services)
Ground transport, which mainly includes ambulance services, is a gray area, but the No Surprises Act still protects it. Rather than a hospital system, insurance companies must run thousands of private ambulance services across the country, each with very different structures and bills. As you can imagine, this is usually done only at the request of the patient.
After the insurance company pays what they think is their portion of the bill, you will be hit with the rest. Many patients must go through public appeals procedures to use the No Surprises Act. It is easier to leverage the act through the more streamlined hospital services than the ground transport services. Work with your ambulance service provider – they want to get paid and they can help you with the proper language you need to provide to the insurance company, so you don’t end up with a huge bill.
Although the No Surprises Act has been in place for some time, private insurance companies rarely follow the rules unless they are called out. Review each bill carefully (if possible, get an attorney to help you) and fight each charge. Also, share this post and tell your friends and family to review their medical bills; it can save you thousands of dollars.
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