Don’t pay that doctors bill

It was never a good idea to rush to pay a bill you receive from a doctor or medical facility. Such a balance bill should never be paid until you receive a explanation of benefits from your insurance coverage indicating the payment by your insurance and your liability. Even when no insurance was involved there was always an opportunity for negotiations on the bill. Trust me, I helped people with their health care bills for many decades. But now things have changed.

A long standing problem has been billing by out-of-network health care providers, especially when the patient had no choice in using the doctor such as in an emergency or even a anesthesiologist and radiologists.

Beginning in 2022

The No Surprises Act will protect consumers from surprise medical bills by:

  • requiring private health plans to cover these out-of-network claims and apply in-network cost sharing. The law applies to both job-based and non-group plans, including grandfathered plans2
  • prohibiting doctors, hospitals, and other covered providers from billing patients more than in-network cost sharing amount for surprise medical bills.

The NSA also establishes a process for determining the payment amount for surprise, out-of-network medical bills, starting with negotiations between plans and providers and, if negotiations don’t succeed, an independent dispute resolution (IDR) process. Source: https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/

There is also some protection if a patient knowingly sees an out-of-network health care provider – provided the physician fails to follow advance notification requirements under the Act.

As with most federal laws, it’s complicated, will take time to implement and is confusing. Nevertheless, don’t pay a health care bill until you determine your actually obligation.

3 comments

  1. Good advice, but…

    Surveys show that only 10% – 24% of “unexpected” bills come from out-of-network providers. That is, between 75% and 90% of the “unexpected” bills people receive are regular cost sharing – deductibles, copayments, coinsurance, tec.

    So, yes, wait for the EOB. But the No Surprises Act won’t address Americans’ failure, to prepare, failure to save for out-of-pocket medical expenses. One change that has yet to take effect is the “Advance EOB”. Perhaps that will focus much more attention on selection of providers and preparing for regular cost sharing – what they sometimes call consumerism.

    Liked by 1 person

  2. Thank you for the info, Dick. I have another issue. I received the benefit info from Medicare and the co-pay balance was what I owed. I waited for the invoice from the emergency (CityMD) provider and paid it. I am receiving texts, emails, and letters for payment. I sent them a letter with a copy of the check showing payment but haven’t received s reply. Is there recourse with the Department of Insurance if this continues or do you have any suggestions? I tried calling their phone number (518 area code) but was on hold for more than one hour!!

    Thank you

    Sent from my iPhone

    >

    Liked by 1 person

    1. If it is a Medigap or Advantage plan File a complaint with the insurance company that covers the benefits after or instead of Medicare. They do not look kindly on providers doing this.

      Liked by 1 person

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