{"id":42,"date":"2022-07-21T17:02:55","date_gmt":"2022-07-22T01:02:55","guid":{"rendered":"https:\/\/medisure.agency\/articles\/?p=42"},"modified":"2024-02-10T10:32:27","modified_gmt":"2024-02-10T18:32:27","slug":"no-more-surprise-medical-billing","status":"publish","type":"post","link":"https:\/\/medisure.agency\/articles\/2022\/07\/21\/no-more-surprise-medical-billing\/","title":{"rendered":"No More Surprise Medical Billing"},"content":{"rendered":"<h4><span style=\"font-size: 18pt;\">Overview<\/span><\/h4>\r\n<p><span style=\"font-size: 18pt;\">According to a report on <a href=\"https:\/\/www.cnbc.com\/2019\/02\/11\/this-is-the-real-reason-most-americans-file-for-bankruptcy.html\">CNBC<\/a>, &ldquo;Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall.&rdquo;&nbsp; In the past, a key contributor to the problem of excessive medical bills was <a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;Balance billing&lt;\/div&gt;&lt;div class=glossaryItemBody&gt; Balance billing occurs when a healthcare provider charges a patient for the difference between the total billed amount for a medical service and the amount covered by the patient&amp;#039;s insurance plan. This situation commonly arises when patients receive care from out-of-network providers. &lt;\/div&gt;\" href=\"https:\/\/medisure.agency\/articles\/glossary\/balance-billing\/\" target=\"_blank\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">balance billing<\/a>.&nbsp; This is also known as &ldquo;<a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;Surprise billing&lt;\/div&gt;&lt;div class=glossaryItemBody&gt; Surprise billing occurs when a patient receives an unexpectedly high medical bill from a healthcare provider, usually because the provider charges more for their services than what the patient&amp;#039;s insurance company is willing to pay. &lt;\/div&gt;\" href=\"https:\/\/medisure.agency\/articles\/glossary\/surprise-billing\/\" target=\"_blank\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">Surprise Billing<\/a>&rdquo;.&nbsp;<\/span><\/p>\r\n<p><span style=\"font-size: 18pt;\">So, what is this phenomenon called &ldquo;<a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;Surprise billing&lt;\/div&gt;&lt;div class=glossaryItemBody&gt; Surprise billing occurs when a patient receives an unexpectedly high medical bill from a healthcare provider, usually because the provider charges more for their services than what the patient&amp;#039;s insurance company is willing to pay. &lt;\/div&gt;\" href=\"https:\/\/medisure.agency\/articles\/glossary\/surprise-billing\/\" target=\"_blank\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">surprise billing<\/a>&rdquo;?&nbsp; Well, to understand the situation better, let me offer a high-level overview of how <a href=\"https:\/\/youtu.be\/2bFvpvLWs0I\">health plans<\/a> offer care.&nbsp; I&rsquo;ll cover three essential and common types of medical care.&nbsp; Routine care, urgent care, and emergency care.&nbsp;<\/span><\/p>\r\n<p><span style=\"font-size: 18pt;\">With routine care, you usually will visit your <a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;PCP&lt;\/div&gt;&lt;div class=glossaryItemBody&gt; PCP stands for Primary Care Physician, which is a healthcare provider who serves as the main point of contact for an individual&amp;#039;s overall healthcare needs. &lt;\/div&gt;\" href=\"https:\/\/medisure.agency\/articles\/glossary\/pcp\/\" target=\"_blank\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">primary care physician<\/a> and your costs will be detailed in your health plan documentation.&nbsp; If you need health care outside of the hours of your <a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;PCP&lt;\/div&gt;&lt;div class=glossaryItemBody&gt; PCP stands for Primary Care Physician, which is a healthcare provider who serves as the main point of contact for an individual&amp;#039;s overall healthcare needs. &lt;\/div&gt;\" href=\"https:\/\/medisure.agency\/articles\/glossary\/pcp\/\" target=\"_blank\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">primary care physician<\/a> practice, many plans will allow you access to an urgent care facility. And once again, your costs will usually be easily looked up in your plan documentation.&nbsp; However, when you have a medical emergency that could involve loss of life, you may need access to the nearest capable hospital. &nbsp;&nbsp;This is where problems could occur with your health plan and its requirements.&nbsp;<\/span><\/p>\r\n<h4><span style=\"font-size: 18pt;\">Health plans<\/span><\/h4>\r\n<p><span style=\"font-size: 18pt;\">So, let&rsquo;s talk about <a href=\"https:\/\/youtu.be\/2bFvpvLWs0I\">health plan<\/a>s.&nbsp; Insurance companies have contracts with providers.&nbsp; A provider is a doctor, <a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;Medical group&lt;\/div&gt;&lt;div class=glossaryItemBody&gt; A medical group is an organized group of healthcare providers who work together to deliver comprehensive medical care to patients. &lt;\/div&gt;\" href=\"https:\/\/medisure.agency\/articles\/glossary\/medical-group\/\" target=\"_blank\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">medical group<\/a>, hospital, laboratory, or pharmacy.&nbsp; Insurance companies negotiate prices with providers for their members.&nbsp; This is how they control costs and offer acceptable premiums for their plans.&nbsp; So, when you need to use the services of a provider, your health plan wants you to use a provider that has negotiated contracts. And that makes sense.&nbsp; These providers, with negotiated rates, are called &ldquo;In-network&rdquo; providers.&nbsp; When you get covered services from in-network providers, you are responsible for a share of the cost. &nbsp;Your share of the cost for covered services is published in the coverage documents of your health plan.&nbsp; However, If you get covered services from a provider out-of-network, you could be fully responsible for the payment of the services.<\/span><\/p>\r\n<p><span style=\"font-size: 18pt;\">Thus, the inadvertent use of an out-of-network provider could have significant financial consequences.&nbsp; And in many instances, the use of out-of-network providers may be beyond your choice and control.&nbsp; For instance, if you&rsquo;re in severe physical distress, you may need to be taken to the hospital in an ambulance (a provider).&nbsp; Once you arrive at an emergency room (a provider), the doctors (a provider) may order x-rays, scans, and labs (a provider).&nbsp; So, with every provider used during the incident, there&rsquo;s a chance you could be treated by an out-of-network provider.<\/span><\/p>\r\n<h4><span style=\"font-size: 18pt;\">The Change<\/span><\/h4>\r\n<p><span style=\"font-size: 18pt;\">Beginning this year, 2022, the government passed the <a href=\"https:\/\/www.cms.gov\/nosurprises\">&ldquo;No Surprises Act&rdquo;<\/a>.&nbsp; The act provides consumer protection from surprise bills.&nbsp; Now patients are only liable for their in-network cost-sharing amount when they need emergency services.&nbsp; There are also requirements for providers and health plans to give patients access to their health care costs.&nbsp; And finally, there is a dispute resolution process.&nbsp;<\/span><\/p>\r\n<p><span style=\"font-size: 18pt;\">These requirements apply to employer group health plans, Marketplace plans, and direct individual plans. This law does not apply to people covered by <a href=\"https:\/\/medisure.agency\/articles\/2024\/02\/01\/a-comprehensive-overview-of-medicare\/\">Medicare<\/a> and Medicaid.&nbsp; They already enjoy similar protections.<\/span><\/p>","protected":false},"excerpt":{"rendered":"<p>Overview According to a report on CNBC, &ldquo;Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall.&rdquo;&nbsp; In the past, a key contributor to the problem of excessive medical bills was <a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;Balance billing&lt;\/div&gt;&lt;div class=glossaryItemBody&gt; Balance billing occurs when a healthcare provider charges a patient for the difference between the total billed amount for a medical service and the amount covered by the patient&amp;#039;s insurance plan. This situation commonly arises when patients receive care from out-of-network providers. &lt;\/div&gt;\" href=\"https:\/\/medisure.agency\/articles\/glossary\/balance-billing\/\" target=\"_blank\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">balance billing<\/a>.&nbsp; This is also known as &ldquo;<a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;Surprise billing&lt;\/div&gt;&lt;div class=glossaryItemBody&gt; Surprise billing occurs when a patient receives an unexpectedly high medical bill from a healthcare provider, usually because the provider charges more for their services than what the patient&amp;#039;s insurance company is willing to pay. &lt;\/div&gt;\" href=\"https:\/\/medisure.agency\/articles\/glossary\/surprise-billing\/\" target=\"_blank\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">Surprise Billing<\/a>&rdquo;.&nbsp; So, what is this phenomenon called &ldquo;surprise [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":44,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"content-type":"","pagelayer_contact_templates":[],"_pagelayer_content":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[3],"tags":[],"class_list":["post-42","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.6 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>No More Surprise Medical Billing - The Medisure Agency Blog<\/title>\n<meta name=\"description\" content=\"Surprise billing can cause serious financial issues - learn what health plans offer &amp; how to avoid excessive medical bills.\" \/>\n<meta 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