If you've ever been surprised by an unexpected out-of-network medical bill, some protections are>How the surprise medical bill protections will work
The new rules apply to private insurers, including those provided through the Affordable Care Act's marketplace (surprise billing is already banned under Medicare and Medicaid).
As of Jan. 1, patients shouldn't receive a surprise medical bill from an out-of-network provider in the following scenarios:
- When you receive emergency care in an emergency room
- When you receive any care at an in-network health-care facility
- When you are transported by an air ambulance (airplane or helicopter)
As well, emergency care providers can't charge you out-of-network rates for services rendered>Limitations to consider
Location matters. These new federal protections>How to protect yourself from a surprise bill
When dealing with a health-care provider, it can sometimes be difficult to get a straight answer on exactly what's covered by your insurer. Kelmar suggests asking, "Are you part of my plan's network?" rather than, "Do you take my insurance?" as that will tell you more about what to expect for actual costs.
Out-of-network doctors may ask you to sign the Surprise Billing Protection Form. Kelmar recommends that you don't sign it until you've read it fully, you have a full estimate of charges and are willing to pay that amount.
Emergency physicians or facilities, assistant surgeons, anesthesiologists, radiologists, hospitalists and intensivists are not allowed to ask you to sign this form. If you do end up signing this form, and it's $400 higher than the estimate, you can dispute the bill by filing a complaint online here or by calling 1-800-985-3059.
If you receive a surprise medical bill after Jan. 1, 2022, contact both the provider and your insurer immediately. If they still insist on payment, you can file a complaint within 120 days online here, or by calling 1-800-985-3059.
