TAYLOR COUNTY—Have you ever received medical care and unexpected costs were billed to you? With the inception of a new federal law, that may no longer be the case.
Beginning this year, the No Surprises Act (NSA) will help to protect individuals from various types of surprise medical bills. And while some states already have laws and regulations to protect patients against surprise billing, those rules do not apply to self-insured health plans, but the NSA will now cover that gap.
According to the Offices of the Insurance Commissioner (OIC), surprise billing happens following rendered care from an out-of-network provider or facility, often without the patient knowing the out-of-network status until a bill is received.
“This can happen in both emergency and non-emergency care,” explained Allan L. McVey, Insurance Commissioner. “It oftentimes occurs when a facility, such as a hospital, is in-network with a health plan, but a provider within the facility is out-of-network with the same health plan.”
Whether a person is under a self-insured health plan offered by employers or is registered with an insurance plan through a health insurance company, beginning in 2022, the NSA will cover unexpected costs.
Under the NSA, patients will be protected from unanticipated bills due to the use of emergency out-of-network services including air ambulance services. The OIC notes that the new regulations do not cover the cost of ground ambulance services.
The new law will also help protect individuals who receive non-emergency care at an in-network facility.
“A facility or provider may not bill you more than your in-network coinsurance, copays or deductibles for emergency services, even if the facility or provider is out-of-network,” disclosed McVey. “If your health plan requires you to pay those fees for in-network care, you will still be responsible for those.”
Under the new law, protections from unexpected medical expenses will be made when an individual receives non-emergency services from out-of-network providers at in network facilities. Again, the provider may not bill for more than the in-network expenses.
“You can never be asked to waive your protections and agree to pay more for out-of-network care at an in-network facility for care related to emergency medicine, anesthesiology, pathology, radiology, neonatology or for services provided by assistant surgeons, hospitalists and intensivists, along with diagnostic services including radiology and lab services,” McVey said.
And while individuals may opt to be treated by an out-of-network provider, they must, in advance, disclose the patients share of the costs. Those who go this route will be responsible for paying the balance bill, as well as their out-of-network coinsurance, copays or deductibles.
“If you’ve received a surprise bill that you think isn’t allowed under the new law, you can file an appeal with your insurance company or ask for an external review of the company’s decision with the OIC,” revealed McVey. “You can also file a consumer complaint with the OIC or with the federal Department of Health and Human Services.”
Those seeking assistance with surprise medical bills or have questions regarding the NSA may contact the OIC’s Consumer Services Division by phone at 1-888-879-9824 or via email at [email protected].
More information may also be obtained by visiting www.wvinsurance.go/no_suprises_act.
Alternately, to initiate a payment dispute or make complaints to federal agencies regarding the NSA, please call the 1-800-985-3059 or visit www.cms.gov/nosurprises.