Back in January, our blog happily announced the passing of the No Surprises Act. Set to take place on January 1, 2022, the new legislation will hold patients harmless from surprise medical bills, such as those from air ambulance providers. Patients are assured that they will only be held responsible for their in-network cost-sharing amounts.
The No Surprises Act will finally put an end to what Sarah Kliff and Margot Sanger-Katz refer to as the most costly and exasperating practices in medicine: surprise medical bills. In an article for the New York Times, Kliff and Sanger-Katz explain that, every year, millions of Americans receive surprise medical bills.
One in five emergency room visits results in a surprise charge.
“The bills most commonly come from health providers that patients are not able to select, such as emergency room physicians, anesthesiologists and ambulances,” Kliff and Sanger-Katz write, “The average surprise charge for an emergency room visit is just above $600, but patients have received bills larger than $100,000 from out-of-network providers they did not select.”
Passed on December 27, 2020, the No Surprises Act will make surprise medical bills illegal. Once in effect, the legislation will make it so that health providers do not directly charge their patients. Instead, they will have to work with insurers to settle on fair prices for medical bills. The new rules and regulations apply to doctors, hospitals and air ambulances.
Ground ambulances are exempted.
On ICD10Monitor.com, Terry Fletcher explains that air ambulances are notorious for sending inflated surprise medical bills to patients who endured critical medical situations. Once the No Surprises Act takes effect, at the beginning of next year, things will change for both air ambulance providers and insurers. They will both have to submit two years of cost and claims data to federal officials for publication in a comprehensive report.
“Patients will be protected from surprise medical bills for emergency services from the point of evaluation and treatment until they are stabilized and can consent to being transferred to an in-network facility,” writes Fletcher, “Protections will apply whether the emergency services are received at an out-of-network facility (including any facility fees) or provided by an out-of-network emergency physician or other providers.”
The average surprise charge for an emergency room visit is a little over $600.
There are patients, however, who have received bills larger than $100,000 from out-of-network providers they did not choose, report Kliff and Sanger-Katz. These include emergency room physicians, anesthesiologists and ambulances.
In their report, Kliff and Sanger-Katz reveal that, last summer, a Pennsylvania coronavirus patient received a surprise air ambulance bill that was over $52,000. The charge was for a flight between two hospitals that happened while she was unconscious. “States that ban surprise bills have been prevented from tackling these cases because federal law bars them from regulating air transit fees,” note the duo. We look forward to 2022 when this will no longer be the case!
At Allegiant Experts, we have decades of experience evaluating medical bills.
In many court cases, we have helped to determine the usual and customary charges for providers in specific geographic areas and fair market value reimbursement for like providers in the same geographic areas. Maybe we can help you! Call us at 407-217-5831 or email us at firstname.lastname@example.org if you have healthcare questions. If we can’t help you, we’ll be sure to point you in the right direction!