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New 'No Surprises Act' won't wipe away all unexpected medical charges

Doctor shortage 110819
Posted at 5:29 AM, Jan 11, 2022
and last updated 2022-01-11 19:29:32-05

If you aren't familiar with the No Surprises Act, the federal legislation which took effect in 2022 bans surprise billing in various instances, giving patients new protections from high out of pockets costs.

Click here to see the I-Team's overview of the No Suprises Act.

For example, if you visit an emergency room that's out of your health insurance's network, this law says your medical charges have to be covered as if they were in-network. But this doesn't mean unexpected medical charges are a thing of the past.

Kris Ender's case can be considered an example of that. At her annual preventative exam, she talked to her doctor about a minor eczema rash she had. To her shock, she was charged $78.65. It was billed to her insurance as an additional office visit.

"It was a normal check-up physical which is supposed to be fully covered," said Ender.

"When you go to a visit you want to be able to ask certain questions. I mean I feel like now I can't ask anything," she said.

Ender's visit happened before the No Surprise Act took effect. But patient advocate Christine Van Haren says charges like these can still happen even with the new legislation in place.

"We are still going to see surprise bills. I think 'surprise bills' is almost a misnomer because I think all bills at this point are surprise bills. We are very surprised at the cost of our healthcare," Van Haren, an independent patient advocate with A Better Way Advocacy.

"They may be surprises to us but they are usually valid charges that we didn’t expect, because the healthcare system and healthcare insurance is so complex and downright confusing."

"It's just a matter of those surprises of which we truly had no control over whatsoever that this is addressing," she explained.

Van Haren says for instance if you went to an emergency room and you were seen by an anesthesiologist who wasn't covered by your plan, the No Surprises Act says you won't be charged an out-of-network cost.

The law also applies to non-emergency care, but it impacts you if you were seen by an out-of-network provider at a medical facility that's in-network.

If for some reason you get a bill for these cases, Van Haren says you're in a good position.

"It eliminates the need to fight over that bill once we get those bills in the mail," she said.

Kris Ender tried to fight that additional charge on her bill with her insurance company and healthcare provider, but didn't have any luck.

She says it's making her think twice about how she handles future doctor visits.

"When they ask me, 'Well do you have any other issues? Nope. I'm good. If you talk about anything at all, there's an extra charge," she said.

Van Haren provided TMJ4 News with additional advice on how patients can navigate medical billing.

When it comes to regular doctor visits, she says before you bring up a healthcare concern, you can always ask your doctor if that will be an extra charge.

Van Haren also encourages patients to really know their health insurance coverage.

"Make sure you know what's in your certificate of coverage for your health insurance plan. Make sure you know what your copays are, what your deductibles are, what your maximum out of pocket is before you get any care really," she said.

Also, she stresses if you have a procedure, a surgery, or even a doctor visit, before you pay the bill, read it carefully to see if your health insurance coverage has been applied. She says you can call your medical provider to double check.

"Call them immediately and you say, 'I got this bill. I just want to make sure you have my insurance information and that it's been submitted."

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