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At the beginning of 2022, the federal No Surprises Act (NSA) went into effect. The new law protects patients across the nation from certain unexpected medical bills, ones which arise mainly from emergency room visits when a patient receives care from a provider who is out of their insurance network. In the past, if a patient got emergency care or was treated by an out-of-network provider, their insurance would a cover significantly smaller portion than if the care had been in-network. The result was that many patients in these situations would be left on the hook for thousands of dollars.
Under the new law, out-of-network facilities and emergency services providers cannot charge patients more than the applicable in-network cost-sharing amount.
However, there are certain situations where patients could still face "surprise bills."
For scheduled procedures (e.g., colonoscopies or gallbladder removals), insurance companies may still charge patients out-of-network prices if they choose an out-of-network doctor or facility. However, the law prohibits surprise bills for additional services from out-of-network anesthesiologists, radiologists, assistant surgeons, or laboratories when the facility and primary doctor are in-network. These additional services must receive the same billing treatment as in-network providers would.
If patients opt for an out-of-network doctor for a scheduled service, they must receive a good-faith estimate of the bill at least three days before the procedure. If the final charges are $400 or more higher than the estimate, the patient can dispute them.
One big surprise is that while the No Surprises Act covers out-of-network air ambulance services, the law does not apply to services from out-of-network ground ambulances, partly because state and local (as opposed to federal) governments manage these vehicles.
Thus, a person flown hundreds of miles to a hospital may end up with a smaller bill than a person driven a couple of miles to a hospital in the same city. But since patients cannot choose which ambulance service (air or ground) will take them to the hospital when they call 911, there is little they can do to predict whether they will be at risk for ambulance bills.
Ambulance services are the largest source of unexpected bills. While only one in five visits to the emergency room led to an out-of-network charge before this year, over half of ambulance rides result in an out-of-network bill.
Meeting with a lawyer can help you understand your options and how to best protect your rights. Visit our attorney directory to find a lawyer near you who can help.