03 Feb 5 Ways You Might Still Get a Surprise Medical Bill Even with the No Surprises Act

A new federal law called the No Surprises Act was recently enacted to protect millions of Americans from being victims of fraudulent business practices by healthcare providers, and shield patients from getting surprise medical bill. The law covers emergency room doctors and out-of-network hospital providers such as anesthesiologists and radiologists who may treat patients without prior authorization at in-network facilities. 

However, even with these closely guarded consumer protections, there are some services that the law does not cover. The gaps in coverage can still leave consumers vulnerable to potential financial losses due to unexpected charges for medical care.

The exemptions from this act could cause financial losses for consumers if they’re unaware of them. Here, we’ll discuss why it’s important for consumers to understand what services are covered and not covered by the No Surprises Act, potential financial losses due to unexpected medical charges and how to avoid surprise medical bill, or how to protect yourself from falling victim to fraudulent business practices in medical care.

The No Surprises Act protects consumers from getting Surprise Medical Bill, but there are still some ways you can get one.

The No Surprises Act helps protect consumers from unexpected medical costs by requiring some out-of-network charges to be covered, but there are still situations where individuals can find themselves with an unexpected bill. Due to the complicated nature of health insurance, administrators and healthcare providers may sometimes submit bills not covered by insurance. Additionally, some providers may charge more than an insurance company would be willing to pay without it being noticed. To stay safe, it’s important for consumers to research what their provider is willing to charge before going through with services in order to avoid any surprises later on.

Understanding The No Surprises Act in Depth 

The No Surprises Act was passed in 2020 as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. It protects consumers from being charged surprise bills when they receive emergency care or care at an out-of-network hospital provider. These charges can be exorbitant and can cause serious financial hardship for many families. The act requires insurers to cover all costs associated with out-of-network services up to certain limits set by the states where the service is provided. This means that if you receive care from an out-of-network provider or hospital, your insurance company will cover up to the limit set by your state without any additional costs. 

However, there are some exemptions from this act. For example, if you receive treatment at an out-of-state hospital or facility that isn’t part of a network contracted with your insurance company, then you may be responsible for any additional costs associated with your care such as copays or deductibles. Additionally, if you receive care at an in-network facility but you see a doctor who is out of network then you may also be responsible for additional costs associated with their services as well as any other services related to your visit such as lab work or imaging studies performed outside of the provider’s office. 

Potential Financial Losses Due To Surprise Medical Bill or Unexpected Medical Charges 

Unexpected medical charges can have a significant impact on consumer finances. These types of charges can include copays and deductibles that were not covered under the terms of their insurance plan; laboratory tests or imaging studies ordered by an out–of–network provider; fees for treatments received outside of a patient’s network coverage area; prescription drugs filled at non–participating pharmacies; and procedures performed at in–network facilities by out–of–network doctors or staff members. All of these types of expenses can add up quickly resulting in significant financial losses for consumers who are unaware that they may be responsible for these costs until after they’ve already received treatment or services related to their visit.

How To Protect Yourself From Falling Victim To Fraudulent Business Practices

 

There are several steps that consumers can take in order to protect themselves from unexpected medical charges related to fraudulent business practices protected under The No Surprises Act.

1. Understand what services are covered and not covered under your insurance plan so that you know what type of financial responsibility you may need to expect should you require care outside of your insurer’s networks.
2. Ask about any extra fees associated with specific treatments before receiving them in order to avoid surprises later on – even if those treatments fall within the scope of coverage provided by your insurer.
3. Third, research alternative providers before making an appointment so that you know exactly which providers accept your insurance plan which can help reduce potential surprises down the road.
4. Contact your insurer directly with any questions regarding possible exemptions prior to receiving treatment so that there are no surprises later on when it comes time to pay bills after receiving medical care or service-related treatments beyond what’s typically covered under most insurance plans.  

If you have insurance, make sure to check that your provider is in-network before scheduling any appointments.

Taking proactive steps to ensure your insurance company is in-network is more crucial than ever, especially if you’ve been a victim of fraudulent business practices. Not checking whether or not your provider is part of your network could mean that you’re left with costly medical bills with no reimbursement. Before scheduling an appointment, take the time to research if the provider you are looking at works within your insurance plan so that you can benefit from lower costs and more extensive coverage. Be sure to do the necessary research before appointments or visits to avoid falling prey to fraudulent medical business practices again.

Even if your provider is in-network, you may still be responsible for charges if they use out-of-network facilities or services.

As a consumer, it’s important to be aware that even if you have insurance and your provider is in the same network as your coverage, you could still be on the hook for charges if they use out-of-network facilities or services without your knowledge or permission. This is especially true in cases of fraudulent medical business practices. At IRONFIST Legal, we fight for your consumer protection rights and help you unravel the mystery of your medical bills to see if you’ve been a victim of unscrupulous business practices by your doctor, medical care facility, or the providers contracted to provide medical care to you or your family members. 

If you’re on a government plan like Medicare or Medicaid, you may still get a bill for things like copays and deductibles.

Shopping around for a good deal or going to the doctor can often prove to be a daunting task, especially if you’re on a government plan like Medicare or Medicaid. Unfortunately, many consumers who are trying to find better options can fall victim to fraudulent business practices and receive an unexpected medical bill. It’s important to understand what is and isn’t covered under these types of plans so that you can prevent any surprise costs in the future. By researching ahead of time and understanding exactly what kind of fees will go towards co-pays and deductibles, you can be sure that you won’t be left with surprises on your bill.

Many consumers fall into the trap of assuming that all of their medical care expenses are covered by Medicare or Medicaid, only to find out much later that there’s an outstanding medical bill with their name on it. Getting informed of expected medical expenses ahead of time is ideal when you anticipate going in for treatment or a medical procedure. But what happens when an emergency arises and you don’t have the benefit of time to figure out your costs and added expenses of treatment?

If you’re ever unsure whether you’ll be responsible for a charge, ask the provider upfront so there are no surprises later on.

Being the victim of fraudulent business practices in medicine can be extremely unfortunate, so it’s important to be aware of the charges involved when initiating service with any provider. To ensure that you won’t be surprised by hidden fees or unwanted charges down the line, it’s worth asking about up-front costs and policies before signing any agreements. Being proactive about finding out this information can help prevent serious financial hardships in the future, giving you peace of mind if something were to go wrong. 

If you’re ever unsure about whether or not you’ll be responsible for payment, make sure to double-check with the provider before signing anything so that there are no surprises later on.

The best way to avoid getting hit with an unexpected medical bill is to do your research ahead of time and ask questions. If you have insurance, make sure to check that your provider is in-network before scheduling any appointments. Even if your provider is in-network, you may still be responsible for charges if they use out-of-network facilities or services. 

How to fight an unexpected medical bill

 

This new legislation isn’t a guarantee that you won’t receive an unexpected medical bill. As with all things new, there’s plenty of room for trial and error as doctors, hospitals, and other medical providers adjust to the rules under the Act. Here are some ways to protect your rights should you be on the receiving end of a surprise medical bill:

Hold off on paying the bill right away.

Your first course of action is to call your medical insurance carrier to see if the provider has submitted the bill for payment. If they haven’t been billed yet, call the provider and ask them to submit the bill to your insurance. Once received, your insurer will then forward to you an Explanation of Benefits detailing the in-network cost-sharing amount you owe for medical services received. Out-of-network providers aren’t allowed to bill you more than this amount. If you’re having trouble understanding your consumer rights or your medical billing, let IRONFIST Legal advocate for your rights. 

IRONFIST Legal will look for medical billing errors and ask for an itemized billing that details the services you’ve received. We’ll go through your medical bill to look for duplicate charges, tests, and services you didn’t get or were unnecessary. We’ll work for you in reporting these errors to your insurance company, your doctor, and your medical care facility. In some cases, we can get your medical bills reduced or eliminated through negotiation or medical contract cancellation.

Get Out of Paying Unexpected Medical Bills

It’s an unfortunate truth that many of us will face a medical bill that we simply can’t afford at one point or another. When faced with this situation it can be difficult to know what steps to take next. It’s important to weigh all the options available and make an informed decision on the best way to cope with the unexpected bill. 

Every consumer should take advantage of The No Surprises Act protections offered through CARES Act legislation. At IRONFIST Legal, we’re aware that on average, up to half of all medical bills contain significant errors. Armed with this knowledge and information, we can help you correct and negotiate your medical bill. In some instances, we can even help you wipe out or reduce any remaining balances.