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Most of us have been there: we’ve gone to the hospital, emergency room, or urgent care clinic for a relatively straightforward reason. Then, a few weeks later, it arrives. The huge medical bill filled with erroneous, trumped-up charges. Charges that you can’t afford.
And that’s exactly what the No Surprises Act aims to stop. In a rare bipartisan effort, the No Surprises Act generally prohibits these “surprise medical bills,” which often charge folks for out-of-network treatments. Instead, any of these large out-of-network bills will have to be sorted out between the insurance company and health providers themselves, leaving the patient completely out of it. The bills will enter arbitration to figure out who will pay the balance on these exorbitant expenses.
After two years of Congress working on the bill, the act will finally go into effect on January 1, 2022.
According to NPR, the Act may also lead to additional benefits for patients. Health professionals interviewed by the news outlet suggested that due to the rules surrounding the arbitration process, health care premium growth may slow. Additionally, another health expert said that the Act may encourage more health providers to join insurance networks.
Horrifying stories of inflated hospital bills have circulated for years. In 2018, a story out of San Francisco went viral when a family took their baby to the ER to ensure their son was ok after hitting his head. He was given a clean bill of health within hours and merely received some infant formula to help calm him down. Two years later, they received a bill for $18,836, which included a fee of $15,666 for something called “trauma response.”
More recently, a similar story from Fort Collins, Colorado caught the attention of the news. A woman in labor went to the hospital to give birth and when they arrived, they were instructed to go through the ER since that was the only open entrance due to COVID. She had a safe and relatively easy vaginal delivery.
And yet she was hit with an outstanding bill for $16,221 including a fee of $2,755 for “emergency services” — purely because they used the emergency entrance as they were told. (For reference, the mother had paid only $30 out-of-pocket for the birth of her first child four years earlier).
It’s these horror stories that the No Surprises Act aims to put an end to.
That said, patients will still need to be vigilant in inspecting their medical bills. Insurance companies are not above trying to slip something past their consumers. In that case, patients have every right to contest the charges and enter arbitration if need be.
To learn more about the No Surprises Act, head here.