You have health insurance, so when you needed to go to the hospital, you chose an in-network facility and assumed everything was good.
After you got home, you find out that one (or more) of the doctors who treated you was not in network, and your insurance company wants you to pay the difference – what’s sometimes called “balanced billing.”
The federal No Surprises Act, which took effect in January, will protect against such nasty surprises.
“The No Surprises Act is an important consumer protection that requires very little actually of the consumer,” said Patricia Kelmar with U.S. PIRG, a non-profit consumer advocacy group.
Under the new law, providers cannot send you a surprise bill in three situations.
“Basically, you will not get a surprise bill from an out-of-network provider, from an air ambulance transportation, or from emergency services,” Kelmar explained. “Or in the situation where you’ve done everything right – you’ve gone to your in-network hospital, and you’ve chosen your in-network physician – none of the other charges from that hospital stay will be able to be charged as a balance bill.”
With any new law, it’s important to understand your rights. The most important thing, Kelmar told me is to look at your medical bills when they come.
“I know it’s not a pleasant thing,” she said. “Open them up, look at them, and compare them to what your insurance company is sending you. Your explanation of benefits will help you identify whether or not a bill that you got is from an out-of-network provider.”
If something doesn’t seem right – you think there are procedures or providers that should have been covered by your insurance — question it. If you get the runaround, file a complaint with the Washington State Insurance Commissioner’s Office.
Washington state residents are protected from surprise billing for a broader set of health services, including behavioral health emergencies treated outside of a hospital emergency room and the services of mobile crisis response teams.
State law also prohibits health insurers or medical providers from asking a patient to waive these critical protections.
More Info: Patient Guide: Surprise medical billing protections you can use
