What You Need to Know About the Surprise Medical Bills Act

More than 50% of Americans have experienced surprise medical bills, with 18% of ER visits resulting in one surprise bill. The exorbitant surprise medical bills might overwhelm you if treated in an out-of-network facility. If you suffer personal injuries from a car accident or construction and require immediate treatment, you can’t dictate which facility to visit.

Now, you don’t have to worry about such bills. The federal No Surprises Act, in conjunction with Colorado’s Out-Of-Network Healthcare Services Law, will protect you from such bills.

Understanding the Federal No Surprises Act

Surprise medical billing means that you received medical service from an out-of-network provider and billed more than your insurance covers. In some cases, this happens unexpectedly and isn’t your fault.

It can happen when:

  • You receive care from a provider you believe is in-network.
  • You had to see whoever was available for emergency care
  • The provider failed to disclose to you upfront its network status.

The Surprise Medical Bills Act, effectively 1 January 2022, curbs surprise medical bills for consumers. The bill would protect you from balance billing and out-of-network emergency room charges. You will only pay the in-network copayment or coinsurance allowed by your health insurance plan.

What It Means for Coloradans

Before the federal No Surprises Act, Colorado had enacted the Out-Of-Network Healthcare Services Law of 2020. This surprise billing law protects you (insured Coloradan) against surprise medical bills. The federal Medical Surprise Medical Bills Act doesn’t replace the state’s law; it’s there to support it.

The federal act provides broader coverage than the state law:

  • Safeguard you against bills from any hospital outpatient, ER treatment, freestanding ER facilities, air ambulance, other ancillary services, and post-emergency therapy before transferring to an in-network health facility.  
  • Prohibits balance billing. The provider can only bill you the same amount as an in-network provider. The out-of-network service provider shouldn’t send you the balance/difference between your final bill and your health plan amount.
  • The healthcare provider should give you information detailing how billing works. They should also provide you with contact information if the provider violates the act’s provisions.
  • The provider must ensure a swift and smooth transition if it leaves the network. The provider might be required to cover you for 90 days or until you no longer need treatment. This provision applies if you suffer from severe medical conditions, inpatient, non-elective surgery, or are pregnant or terminally ill.
  • If you are uninsured, the provider should give a ‘good faith estimate’ of all primary and secondary services and items costs. If your final bill that $400 higher than the good faith estimate, you can dispute it within 120 days of the date on the bill.

What If You Experience a Personal Injury?

If you sustain a personal injury, there’s no time to deliberate which hospital or ER facility to seek treatment. The ambulance (ground or air, depending on the severity of your injuries) will transport you to the nearest ER facility or trauma center for immediate treatment.

In most cases, the healthcare givers focus on treating you rather than contacting your insurer to ask for relevant health insurance information. If that facility isn’t in-network, or your cover doesn’t entirely cover that facility’s charges, you’ll experience a balance billing. In such a case, the No Surprises Act covers such excess bills from personal injuries.

Where to Find More Information

Before any medical procedure, check with your insurer and healthcare provider about their network status. If you have questions about the Surprise Medical Bills Act, you can reach the No Surprises Act helpline at (800) 985-3059 or submit an online complaint form.  

If you believe a healthcare provider has violated your rights, contact Cave Law today for a free consultation.