Healthcare Surprise Billing

This week I am excited to bring you some information about a new change that will be coming relating to health care billing. As of January 1, 2022, there is new legislation going into effect that will eliminate healthcare surprise billing.

I am sure that most people have had some kind of experience with surprise billing – where you as the patient do your due diligence, and make sure you use an in-network hospital when you need to have something done. And then lo and behold, you get a surprise bill. It becomes apparent that one of the providers you used while you were in the hospital is not networked, and now they want you to pay an exorbitant full fee. And often you find out that this provider is hardly networked with anybody. This comes as a big surprise to consumers, as they chose an in-network hospital.

So as of January 1st, the legislation that will go into effect will eliminate this. So what does that mean? This legislation will apply to true surprise billing. This is when you were not informed ahead of time, and that you didn’t have a choice. For example, if you go in and have a baby, and you get whoever’s on call. With this legislation, what’s going to happen is that the charges are going to be filed to the insurance company, and the insurance company and the provider will have to work out an agreement of what they will pay. A great positive to this is that it basically forces these out-of-network doctors not to charge exorbitant fees because the insurance company is going to make an offer to the provider of what they are willing to pay. If the provider chooses not to accept the offer, then there’s a third party that gets involved. And then both the insurance company and the provider have to abide by the third party’s ruling. So the third party will decide what should be paid by the insurance company and what the provider has to accept.

The benefit of this is that you’re not involved, you as a consumer do not have to handle this. One of the things I do for my clients is to help them negotiate and learn how to avoid these big bills. But this is going to be a huge step forward that will eliminate you as a client having to do this.  Remember, if the provider is paid in full from the insurance company, you then won’t have a big bill. If they’re not paid in full, however, you still may get a balanced bill, but it should be remarkably less than it would have been before. And if it’s not an affordable amount, again, we may be able to negotiate that with the provider.

This legislation has been a long time coming, and it is meant to protect consumers. What would not count a surprise billing? If they were to notify you at least 72 hours ahead, and you have the option of obviously accepting or denying the services, then it’s not surprising billing. If you have some kind of procedure, and they go over it, even on the same day, if it’s at least three hours before, then this is a little tricky rule. But again, they have to give you time to make a choice.

Where I think this new legislation is going to get interesting is if there are no in-network doctors. I think in most cases these providers are not going to know that they’re going to be stuck accepting what the insurance company is going to pay them. Because they don’t know when someone’s going to have a baby; they can’t call you 72 hours ahead unless you have a scheduled C section. If it’s not a scheduled C section when you’re having the baby, the pediatrician on call could be out of network, and they’re not going to be able to call you 72 hours ahead. So this is real legislation that is really going to help protect consumers, which is a lot of my focus when I help people figure out what insurance is right for them.  Figuring out the best way – whether to use insurance via cash pay or negotiate bills after the fact – because my whole point is to save you money on the bottom line. If I can save you in premium and save you in out-of-pocket costs, it’s a win-win for you as a client.

So hop on over to my page if you want to schedule a consultation with me to review your health plan choices and discuss healthcare surprise billing, please do that. I’ll be super busy during open enrollment and so I prefer online appointments rather than trying to call me because more than likely I’ll be on the phone and not able to answer your call.

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