Fred Goldenberg: Fewer Surprise Medical Bills | Business

Fred goldenberg

Being rushed to hospital for emergency medical intervention is bad enough. But a month later, receiving a “surprise” bill for services from a doctor you’ve never heard of or had a chance to choose from only adds insult to injury.

Yet these surprise bills have arrived and billions of dollars have been paid by unsuspecting consumers year after year.

The question is: why are you receiving the invoice in the first place? You hit your very high deductible and handed in your credit card for your co-pay, so why did you get the bill? When you call your carrier, you are informed that although you have met all of their payment requirements, the additional bill is from a doctor who is not on their network, and it is your responsibility.

In the past, there was nothing you could do but reluctantly foot the bill.

This was the situation until January 1, 2022.

In 2020 under the Trump administration and refined in 2021 by the Biden administration, Congress passed bipartisan legislation that bans surprise medical bills.

In a surprising show of solidarity, Congress passed this important consumer protection bill that relieves surprise bills covering nearly all emergency medical services and most routine care.

“I think it’s so pro-consumer, it’s so pro-patient – and its effect will eventually be felt by literally everyone who interacts with a healthcare system,” said Sen. Bill Cassidy (R-LA ), one of the bipartisan lawmakers who wrote the law.

Even with insurance coverage, especially for those under 65, emergency medical procedures can be expensive. High deductibles and co-payments can add up to huge personal expenses. This new law will eliminate off-grid doctor or hospital bills from appearing in your mailbox.

Unsurprisingly, medical providers are still battling with lawmakers and the Department of Health and Human Services over how they will be paid for the off-grid services they provide. But these issues are not expected to affect the protections consumers have gained through this legislation.

So if you find yourself in an emergency room or emergency care, you can expect to pay only your plan co-pay – and no more.

But if you are due to have elective surgery or a procedure, such as a colonoscopy, and you choose to have it done at a facility that is not part of your medicare network, this law not you avoid paying higher service charges. So make sure that the installation you are going to use for non-urgent procedures is networked.

Although this law covers the majority of medical situations, there is one medical expense over which most of you have no control: transport by land ambulance.

According to KFF Health System Tracker, ambulances bring around 3 million people with private health insurance to the emergency room each year.

Only 11 states (Michigan is not one of them) have laws that protect consumers from “surprise” billing by ambulance companies.

The reason for the establishment of ground ambulance services is that they are regulated by local or state governments and in many cases they are prohibited from contracting as network providers.

In 2020, 37% of emergency ground ambulance trips were made by local fire departments, 25% by other government agencies, 30% by private companies and 8% by hospitals.

KFF found that 51% of emergency ground ambulance trips and 39% of non-emergency ambulance trips included an off-grid charge for ambulance-related services, which may expose privately insured patients to a surprise bill. .

With one in 10 emergency room visits for privately insured patients starting with an ambulance ride and only 11 states protecting them from “surprise” billing, you can be assured that this may be one of the more frequent trips. more expensive than you have ever had. I don’t overlook the life-saving aspects of the service, but a bill of several hundred dollars, if not thousands, can be quite shocking.

With medical costs soaring and the pandemic soaring, some relief and protection from surprise bills is a step in the right direction. We have a long way to go, but this law proves that we can work together to help people through difficult times.

Fred L. Goldenberg is a Certified Senior Advisor (CSA) and owner of Senior Benefit Solutions, LLC, a certified health insurance and financial services organization now affiliated with Michigan Planners in Traverse City. Questions or comments on this column or interest in our monthly health insurance courses can be directed to (231) 922-1010 or [email protected]

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