New Law Protects Against Surprise Medical Bills

The healthcare in our country is as famous for being amazing as it is notorious for being expensive. Even with insurance, people are forced to pay astronomical copays and extra fees for services they need to survive. Those without insurance can and do die simply because they cannot afford treatment. It is downright evil, seeing innocent people beg for money from strangers for life-saving medical care they’d be guaranteed in almost any other country.

As scary as it is and can be, though, it is starting to improve. The tragedy of the COVID-19 pandemic has shone a new light on healthcare in our country and, slowly but surely, laws are changing accordingly. It is nothing perfect, but a new law regarding hospital pricing will save millions of Americans millions of dollars. Unfortunately, you cannot trust for-profit hospitals and doctors to let you know about these changes, so make sure you know your rights before someone challenges them.

Understanding what and who the new bill protects

Although certain states already had laws like this in place, it is now a country-wide mandate that insured patients can no longer be hit with surprise insane medical bills if they have been inadvertently seen by an out-of-network provider. This means if you go to the hospital for an emergency and it ends up not being in-network, you cannot get saddled with the giant bill. It’s called the No Surprises Act, and it brings much-needed protections to Americans all over the country.

If you have health insurance through your employer, this new law:

• Bans surprise medical bills for emergency services even if it does not have prior authorization and is out-of-network
• Bans most cost-sharing between in-network and out-network emergency services
• Bans charges for extra but necessary services like radiology that may be done by an out-of-network provider when one is in an in-network medical facility
• Requires that all medical providers give you an easy-to-understand notice explaining these protections in detail and who to contact if you believe they have been violated

Even if you do not have health insurance, this bill still ensures you are given a good-faith estimate of costs before treatment, so you are never surprised. Again, this is not perfect, and it certainly does not make everything better. But it does — and will — help, especially in cases where you need emergency services like a health scare or accident. We cannot predict everything, and we cannot protect ourselves against everything either. If the worst happens, you should not have to wake up in debt.

Does the new federal law replace Illinois’ law about surprise bills?

Nope. The federal law is a supplement to state laws, and provides a “floor” for patients in states without surprise billing laws. In Illinois, you’re protected by Public Act 096-1523, which guarantees that “you cannot be charged greater out-of-pocket expenses than you would have been for covered, in-network physician or provider services.” The Act specifies the following services as covered:

• Radiology
• Anesthesiology
• Pathology
• Neonatology
• Emergency physician services

So in our case, the federal law ensures that you’ll get an estimate for the services, but all other protections were already guaranteed.

What to do if you’re charged with a surprise medical bill

As previously mentioned, it is an unfortunate reality that most hospitals and healthcare providers operate on a for-profit basis, putting money above caring for their patients. This means that, while you may still receive the treatment you need, there is no guarantee you’ll be told you have to pay for it. They certainly will not let you know when they are giving you a bill that is now illegal, even though they are required to.

For better or worse, you will need to be the one paying attention. No, it is not fair, but since the law is on your side, you do have protections available to you. So if you receive a surprise medical bill for something you know should have been covered, you are not expected or required to lay down and take it. Your first step should be calling your insurer to see if they can validate the bill. If they are unable to, take the bill to your provider and question the charges. Per the Centers for Medicare & Medicaid Services (CMS), you can dispute your bill if:

• The service was provided in 2022,
• Your actual bill is at least $400 more than the estimate, and
• You file the dispute within 120 days of the billing date.

In the event that they hold their ground and insist the charges are legal and fair, you can submit an official complaint to the federal government to have them investigate it. Providers who are found breaking this law face hefty charges along with losing whatever they expected to gain from you.

While you are waiting for the investigation, do not pay anything towards the bill, as that is a sign of accepting responsibility. It takes time for medical debt to show up on your credit, so try not to panic if your provider sends the bill to collections. It will be okay. You are not in the wrong.

Whatever the reason, if you suspect you have been mistreated, misinformed, or injured by a medical professional, you need an attorney on your side as quickly as possible. There is a statute of limitations for fighting these fights, so the sooner you are able to get started, the better. Contact Gainsberg Injury and Accident Lawyers in Chicago if you were hit with a surprise bill, or if you have been harmed by a medical provider. To learn more for free, call us today at 312-600-9585 or use our contact form.