What To Do In The Event You Receive A Surprise Medical Bill


As we’ve blogged about on numerous occasions, the No Surprises Act went into effect at the beginning of this year. The new law makes it so that unsuspecting patients are no longer on the hook for medical bills from out-of-network health care providers or those they didn’t choose. Such unexpected bills may also include charges a patient didn’t known he/she received. The NSA protects people whether they have health insurance or not.


While the law seeks to prevent surprise medical bills, it is still possible for people to receive them. So what should be done in the event you receive a surprise medical bill?


Contact your insurance company.


Look into whether or not the provider submitted the bill to your insurer yet. If the bill was not yet submitted to the company, contact the health care provider. Request that the bill be sent directly to your insurance company.


“Once it has received it, your insurer should send you what’s known as an EOB, or Explanation of Benefits, that will include the in-network cost-sharing amount you owe for this service,” explains Lisa L. Gill of Consumer Reports, “The out-of-network provider is not allowed to bill you for more than that amount.”


File an appeal.


According to the Consumer Financial Protection Bureau, if you have insurance and receive a bill that indicates a denial of all or part of your claim or a service, you can appeal the decision. They point out that your plan documents should contain information about the review process and how you can request a review of your plan’s decision. If you do not have insurance, you should receive a good faith estimate of costs for your care from your provider.


“After you get the care, if you are billed for an amount more than $400 over the good faith estimate and you got the bill within the last 120 calendar days, you can use the new dispute resolution process to determine the final payment amount,” reports the bureau, “This process uses a third-party arbitrator to review the good faith estimate, the final bill, and any other information submitted by your provider or facility.”


Request an itemized bill.


Although it may be time consuming and frustrating, it’s important to go through your medical bill with a fine tooth comb. Getting an itemized bill helps you to determine if there are any duplicate charges or charges for procedures, tests or services you did not get, says Gill. She encourages patients to report errors to their insurance companies, hospitals and/or doctor’s offices.


“It’s estimated by the Patient Advocate Foundation that up to half of all medical bills contain significant errors,” Gill informs, “You can also compare the average cost for specific procedures in your ZIP code by looking them up in the healthcare bluebook.org.”


File a federal complaint.


Remember that you are protected by the No Surprises Act. Gill affirms that the new law establishes a national consumer complaint system for surprise medical bills. You can file a complaint online or call 800-985-3059 between 8 a.m. and 8 p.m. EST, seven days a week.


Learn more about the No Surprises Act.


Visit CMS.gov/nosurprises. You may also call the Help Desk at 1-800-985-3059 for more information. To get in touch with Allegiant Experts to learn all about our health care consultancy, please don’t hesitate to call us at 407-217-5831 or email us at info@allegiantexperts.com.

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