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Surprise Medical Bills In The Age Of The No Surprises Act


Even though it seems like the prices of everything have skyrocketed in 2022, the bills that patients receive for emergency room visits have gotten less expensive.  Pursuant to the No Surprises Act, healthcare providers cannot charge patients out-of-network prices for emergency medical services provided on or after January 1, 2022.  In other words, even though almost all health insurance plans cover emergency room visits, the coverage does not extend to the ER physicians, anesthesiologists, and radiologists who treat you during the ER visit.  Before the No Surprises Act went into effect, it was a matter of chance whether the doctors who treated you in the ER were in-network for your insurance company, and if they weren’t, they could each send you an out-of-network bill for hundreds of dollars.  Pursuant to the new law, everyone who treats you on an emergency basis must bill you for an amount that does not exceed what an in-network provider would bill you for those same services; the law requires the insurance company and the out-of-network provider to settle up for the rest of the amount between themselves.  This means that ER visits in 2022 are less financially disastrous than ER visits in previous years, but medical debt is still a widespread problem, and it isn’t going away anytime soon.  A Plantation debt lawyer can help you with new and old medical debts.

Who Decides What Counts as an Emergency?

Despite that it has already prevented numerous financial catastrophes, the No Surprises Act contains several loopholes that enable medical debt to continue piling up.  First, it does not apply retroactively; therefore, it does not make the out-of-network bills from last year disappear.  Second, it defines “emergency services” more narrowly than most patients understand the term.  It always applies to hospital emergency room visits, but only some urgent care clinics are considered emergency medical service providers.

Don’t Pay Hundreds or Thousands of Dollars for Someone Else’s Mistake

The No Surprises Act gives patients the right not to pay more for emergency services than the in-network rate guaranteed by their health insurance plans.  Why do these big bills keep coming, then?  Sometimes it is because of the fuzzy definition of “emergency” according to the No Surprises Act.  Other times, it could simply be a mistake.  The medical billing clerk at the hospitalist physician’s office or staffing firm might have written herself a note that she contacted the insurance company, but she might mistakenly send you the bill before the insurance company has lowered the amount.  Therefore, if you get a bill that seems too expensive, you should always ask questions before you pay.  Call the phone number on the bill itself, and call your insurance company.  If you have not already received one, ask the insurance company to send you an explanation of benefits and look up the insurance codes.

Contact a South Florida Debt Lawyer About Surprising or Unsurprising Medical Debt

A South Florida debt lawyer can help you if you are still struggling with medical debt in the age of the No Surprises Act.  Contact Nowack & Olson, PLLC in Plantation, Florida to discuss your case.



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