Medical debt is a burning issue in the country. According to the journal of the American Medical Association, people owe almost $140 billion on medical bills. According to HealthsystemTracker.org; one in five Americans are financially devastated due to surprise medical bills from the emergency department. This is almost the same number of people who are in financial hardship due to expected bills from non-emergency hospital stays.
Two out of 3 Americans aren't sure if they can pay those unexpected medical bills. Almost 50% of them can't afford to pay off that debt.
Thanks to the No Surprises Act, Americans can at least get some respite from surprise medical bills from 2022 onwards. Here's how.
How does the No Surprises Act protect Americans from those expensive surprise bills?
The federal law protects consumers from unexpected out-of-network medical bills. This includes bills from healthcare providers that are not in your health insurance network.
The Act forbids balance billing. Now, what is balance billing? It is the difference between the amount charged by the hospital, and the amount paid by the insurance company.
Previously; the patient had to pay the amount. The bills could range from hundreds to thousands. Normally, this happens when patients are taken to the emergency department that is out of the patient's health insurance network. Nevertheless, what if the patient is taken to the hospital in their network? Well, even then, the patient could end up with an unexpected bill.
What's the reason?
The reason is simple. The doctor is out-of-network.
The new law mandates that the hospital and the insurance company have to work with each other and settle the deficit balance. The patient has nothing to do with it.
The new bill has many more provisions to protect consumers from unexpected medical bills.
Doctors have to inform patients how much they have to pay for the consultation in a scheduled visit. Moreover, this is especially applicable when the doctor is out-of-network.
Consequently, the bill also covers providers' charges that patients can't choose. Furthermore, as an example, pathologists, radiologists, and anesthesiologists in hospitals can't issue unexpected medical bills for those out-of-network charges.
The last two years have been stressful for Americans due to the pandemic. The government wanted to protect consumers from the burgeoning medical debt. As such, several hospitals received notices for implementing changes before January 1, 2022.
The new law applies to private health plans, non-group health insurance policies, grandfathered group health plans, and Federal Employees Health Benefits Program.
Which bills are not covered by The No Surprises Act?
In most emergency care cases, patients don't know where they are admitted or who provides their treatment. Again in the non-emergency hospitalizations, patients don't know if the multiple providers are out-of-network. The law aims to change this scenario.
The Act covers medical bills for the services you receive in hospital emergency departments, urgent care centers, and freestanding emergency facilities. The No Surprises Act also covers bills for air ambulance transportation.
The Act proposes to set up an advisory committee to come up with several options for protecting consumers from unanticipated ground medical bills.
However, bills arising in specific situations are not covered under the No Surprises Act.
For example, if the providers issue a written notice at least 72 hours in advance and the patient confirms it, the health insurance plans are not required to cover bills for those non-emergency services. The notice should clearly mention the following points:
● If the provider is out-of-network.
● Good faith estimate of the charges.
● A List of providers in the facility. The patient has the discretion to choose among them.
Again, if you are not aware of the fact that your health insurance plan has a high deductible and hence get surprised to see the amount you have to pay on your medical bill, it won't be covered under the No Surprises Act.
What if there is a dispute on the payment amount arising from surprise medical bills?
The law mandates that the surprise bills have to be covered without prior authorization. Plus, the law clearly states that the in-network cost-sharing must apply based on the median in-network payment amount for similar services. In short, health insurance plans are required by law to cover surprise bills at in-network rates.
However, if there is a disagreement about the payable amount for the surprise out-of-network medical bills, an independent dispute resolution (IDR) process will resolve it within 30 days when the negotiation process is going on.
What if health care providers or insurers violate the new law?
If you feel that your health insurance plan has not accurately covered a surprise medical bill, you can make an external federal appeal.
If the health care provider has violated the law, you can file a complaint with The Secretary of Health and Human Services. If they are found guilty, health care providers may have to pay a fine of up to $10,000 per violation.
All state governments have to implement the law. If the state government doesn't implement the new medical bill, the federal government will enforce it.
Conclusion
Expensive medical bills and payday loans are a menace to society. It's great that the federal government has passed the bipartisan bill to provide consumers with much-needed financial relief. It's high time the federal government does something about high-interest payday loans. The government should enact a law for the people who need payday loan debt assistance, and it's required. Otherwise, lenders would continue to charge 500% interest on their loans and exploit borrowers financially.