JustCare

Category: Health insurance

  • Bi-partisan bill in Congress would prevent surprise medical bills

    Bi-partisan bill in Congress would prevent surprise medical bills

    Millions of insured Americans go to the hospital, thinking that their bills will be covered only to be surprised by unexpected medical bills. Too often, they end up in medical bankruptcy. Out-of-network doctors and other health care providers may charge people tens of thousands of dollars. Finally, there’s a bipartisan bill in Congress that would prevent surprise medical bills.

    Senator Cassidy (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO) have introduced S._____  The bill would forbid out-of-network care providers from billing patients for their services over which the patients have no control. These bills usually are a result of patients needing emergency hospital care and having no ability to ensure  the hospital they are taken to or the providers who treat them are in-network.

    The bill would protect patients from having to pay out of pocket for out-of-network care any more than they would pay for in-network care. Their health insurance would pay any additional charges up to a designated limit.  This bill would make a major difference for thousands of patients. Kaiser Health News has reported that people have received surprise bills for a $17,850 urine test and for $109,000 after a heart attack.

    The Senate bill would also protect emergency room patients in an out-of-network hospital once they are stabilized. At that point, the hospital would have to notify them in writing that they will be billed for its out-of-network services. The patients could sign a waiver agreeing to pay privately for that care. Or, they would have the right to move to an in-network hospital.

    More than half of all workers with health insurance through their employers (61 percent) are in self-funded plans. The employers pay claims directly rather than through insurance. And, out-of-network hospitals and doctors today can charge these plans what they will. This bill would no longer allow this type of balance billing.

    For now, here’s how to protect yourself from surprise medical bills.

    Here’s more from Just Care:

  • How to protect yourself from surprise medical bills?

    How to protect yourself from surprise medical bills?

    Watch out for huge medical bills if you visit the emergency room and are enrolled in a commercial health plan. They are common, and Kaiser Health News reports that these bills are often permissible. What should be done to end surprise medical bills? Medicare for All, of course. How can you protect yourself from surprise medical bills?

    In today’s commercial health care system, you want to avoid out-of-network emergency care if at all possible. Plan ahead and identify the emergency room in your health plan’s network and the in-network ambulance that will take you there. If not, here’s one example of what can happen: In the Spring of 2017, St. David’s Medical Center charged a teacher $108,951 for his four-day emergency stay after a heart attack. St. David’s, in Austin, Texas, is operated by HCA Healthcare, the nation’s largest for-profit hospital chain. The teacher’s insurance had paid $56,000 for his out-of-network care. But, the hospital billed the teacher for the difference.

    Fortunately, the story got a lot of media attention. And, shortly after Kaiser Health News and NPR reported it, St. David’s  cut its bill down first to $782.29 and then to $332.29. But, what about all the people with exorbitant medical bills that do not get major media attention?

    What’s particularly noteworthy is that the reduced bill does not reflect St. David’s acknowledgement of billing errors on its part. The hospital’s original bill was intentional. Indeed, the hospital claims it “did everything right in this particular situation.” How? The hospital had let the teacher know that he might be able to get a “discount” on his bill based on his income. 

    The issue, of course, is the legitimacy of St. David’s charges. It stretches credulity that the teacher’s four-day stay could have cost the hospital anything close to the amount it billed. The fact that it slashed the additional charge down to a few hundred dollars immediately after it came to public view also suggests the bill should not have been sent.

    But, in this case, the teacher had insurance through his employer’s self-funded health plan. And, according to Kaiser Health News, ERISA, the federal law concerning self-funded health plans, allows hospitals and doctors to charge patients receiving out-of-network care seemingly whatever they please on top of what their employer plan pays. About six in ten people with employer coverage are enrolled in an ERISA plan.

    Surprise hospital bills are pervasive, particularly when people are seeking emergency care. Some states have stepped in to protect their residents from surprise bills in a limited way. But, not enough. And, Congress has yet to address this serious issue. According to Congressman Lloyd Doggett, “This is a nationwide problem, and we need a nationwide solution.” 

    If your health care coverage is not from your employer through a self-funded ERISA plan, you should be protected from some of these exorbitant surprise bills. The Affordable Care Act permits out-of-network hospitals to bill patients only what they would have paid in an in-network hospital. That said, the ACA still allows out of network ambulances, doctors and hospitals to charge patients for whatever their health plans do not pay.

    If you get surprise medical bills, you should appeal to your health plan to pay them. And, if that does not work, contact your Congressman and Senators as well as your local newspaper and Kaiser Health News to report your story. It’s important to keep the pressure on Congress to address this issue.

    No one should be forced into extreme medical debt or bankruptcy because of a medical or hospital bill, or for that matter, a prescription drug bill. Medicare for All would put an end to these bills. Not surprisingly, the majority of Americans support Medicare for All and an ever increasing cohort of Democrats in Congress do as well.

    If you support Medicare for All, please let Congress know. Sign this petition.

    Here’s more from Just Care:

  • People shouldn’t need to shop for health care

    People shouldn’t need to shop for health care

    Austin Frakt reports on a new NBER study that finds that only one in 100 Americans shop for lower-cost health care, even when it comes to simple elective procedures like MRIs. Rather, they go where their doctors direct them even when they could save money going elsewhere. The study does not consider people’s desire for quality care.

    Last September, Kaiser Health News reported on similar findings published in Health Affairs. While comparison shopping could lower your out-of-pocket costs for some tests and procedures, here are six reasons why people should not need to shop for lower-cost health care. Note that people with traditional Medicare do not need to shop for health care to save money; it’s only people with commercial health insurance.

    1. First, continuity of care is important for better health, and we should not be moving from one doctor to another based on the cost of a particular treatment.
    2. Second, as a general rule, when we visit the doctor, we often receive a battery of services that we could not have predicted. So, even if our doctor charges more than another doctor for the treatment we plan to receive, the other doctor may provide additional services we could not predict that end up costing us more.
    3. Third, all doctors and hospitals are not created equal. So, paying less may not mean saving money. And, it could mean getting poorer care. At this juncture, we still have little clue about differences in health care quality among doctors or hospitals. It’s smart to see doctors who come highly recommended, because they have experience and a good reputation for treating people with your condition. Finding these doctors is not always easy, but if you can find them, paying more upfront, could mean paying less later on. (Here are some tips for choosing a doctor.)
    4. Fourth, 60 percent of hospital spending is for non-elective services, for which we are unable to shop around, be they emergency services or services in hospital over which we have virtually no control. So comparison shopping is out of the question. We are saddled with bills at whatever level the hospital, in collaboration with our health insurers, is able to set them.
    5. Fifth, many people have cognitive impairments and other functional limitations that prevent them from comparison shopping. It’s wrong for our health care system to penalize them.
    6. Sixth, most of us are busy working all day, without the time or flexibility to shop around for lower-cost services.

    Unlike Medicare, our current commercial health care system permits irrational pricing and price-gouging and offers people very little information to make informed health care choices, even when they have the time and wherewithal to make them.

    With improved Medicare for all, we wouldn’t need to worry that our doctors and hospitals were gouging us. Prices would be set, as they are with Medicare. And, in a humane health care system, we all would be able to afford needed care. Traditional Medicare comes closest to that system, though you need supplemental insurance coverage to budget for your care.

    Here’s more from Just Care:

  • If your health plan denies payment, fight back and appeal

    If your health plan denies payment, fight back and appeal

    It likely won’t be your first reaction, but when your health plan denies payment, fight back and appeal.  You should absolutely challenge that denial.  If you have Medicare, it’s easy to appeal, it won’t cost you anything, and the odds are high that you will win, saving yourself a lot of money.

    One of the best-kept Medicare secrets is that the vast majority of people who challenge a Medicare denial win.  But, almost no one makes the challenge and appeals. Be sure to read your denial notice carefully and follow the procedures listed on the form.

    With traditional Medicare, if you are denied coverage for a doctor or other medical service, all you need to do is return the Medicare Summary Notice (MSN) form to Medicare, circle the denial and fill out the section at the bottom of the MSN for the Medicare insurance carrier to review the denial.  It’s that easy.  Even if the doctor made you sign an Advance Beneficiary Notice that Medicare will not cover the service, you should appeal.  The doctor could be wrong, especially if the doctor says that the service is medically necessary.

    If Medicare is denying a hospital service, a home care service, hospice care or a service from a skilled nursing facility, you should also appeal. How to do so, depends upon the particular service you are appealing. The denial notice explains what to do. And, keep in mind that if the Medicare provider did not tell you in advance that it believed Medicare would not cover the service and have you sign a waiver agreeing to pay privately, you are not liable for the cost of care. If you did sign the waiver, you have the right to demand the provider bill Medicare. It is highly possible Medicare will cover the care, especially if you get a letter from your treating physician explaining why the care was medically necessary.

    With a Medicare Advantage plan or other private health plan, call the health plan and ask the insurer to explain why you were denied coverage. You will likely need to speak to the doctor about the coverage denial.  It could be that the doctor coded the procedure incorrectly or did not comply with health plan rules and that the doctor should be responsible for the cost.

    If you are not able to resolve the matter, file an appeal with your insurer.  You will likely need a formal written notice of denial to do so.  It is helpful to have a letter from your doctor explaining the need for your care.  So long as the care is medically necessary, your insurer should cover it.

    To appeal a Part D prescription drug denial, the Evidence of Coverage document you get from your plan explains your rights, including how to appeal. You can also call your plan. If possible get a written letter from your doctor explaining why you need the particular drug your Part D plan is denying.

    There are several appeal levels, so even if you don’t win at the first level, appeal again.  If you have Medicare and need help, contact your state health insurance assistance program (SHIP) for free assistance. You can get the number for your SHIP here.

    N.B. Even with commercial health plans, according to a report from the General Accountability Office, “coverage denials, if appealed, were frequently reversed in the consumer’s favor. . . . [D]ata from four of the six states on the outcomes of appeals filed with insurers indicated that 39 percent to 59 percent of appeals resulted in the insurer reversing its original coverage denial. “

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  • CARE Act assists family caregivers

    CARE Act assists family caregivers

    About seven in ten older adults need long-term care at some point. In many cases, it is a family member who provides that care to help them remain in their homes as long as possible and stay out of nursing homes and other institutions. The CARE (Caregiver Advise, Record, Enable) Act is designed to assist family caregivers, by helping to ensure a smooth transition when the people they care for are moving between home and hospital.

    Family caregivers provide a wide range of caregiving services, from simple non-health related chores such as cleaning, cooking, and transportation to medical services such as medication management, wound care, injections and operating medical equipment. AARP reports that about 20 million family caregivers in the US perform these medical services for the people they love. It is important for family caregivers to know when the people they love are leaving the hospital and what types of care they will need when they return home.

    In states that have implemented the CARE Act, hospitals must include the names of family caregivers in patients’ medical records. Hospitals also must alert family caregivers when their loved ones are about to leave the hospital. And, hospitals must provide family caregivers with information on how to perform needed medical services after their loved ones return home from the hospital.

    The CARE Act is law in 36 states, as well as the District of Columbia, Puerto Rico, and the US Virgin Islands. States that have passed the CARE Act are: Alaska, Arkansas, California, Colorado, Connecticut , Delaware, Hawaii, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennslyvania, Rhode Island, Texas, Utah, Virginia, Washington, West Virginia, Wyoming.

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  • Before paying drug copay, ask cash price

    Before paying drug copay, ask cash price

    A new JAMA research letter reports that people are paying drug copays that are higher than the drug’s cash price more than 20 percent of the time. So, before paying the drug copay, ask the drug’s cash price. You may save yourself some money.

    While copays should represent a portion of a drug’s costs, there is nothing in the law that requires pharmacy benefit managers or insurers to set the copay below the drug’s cost. So, they are requiring people to pay copays that can far exceed a drug’s cost. And, they are literally gagging the pharmacist from disclosing to you that you can save money on the drug if you do not use your insurance.

    The solution is simple. Congress should step in and require insurers to charge copays that are no higher than the drug’s cash price. Moreover, Congress should require that pharmacists disclose to patients whenever a drug costs less than a copay. And, finally, Congress should require that insurers include members’ out-of-pocket cost for any drug purchased on formulary in the members’ total out-of-pocket costs, if the payment is for less than the copay amount.

    There should be a way for people to expose insurers that are charging them copays that are more than the cost of the drug. And, anyone in one of these insurers’ plans should have the right to leave their health plan and transfer to a different insurer.

    The research reveals that in 2013, overall, people overpaid for their drugs 23 percent of the time; 28 percent of the time for generic drugs specifically. People’s overpayments tended to be for generic drugs. And the overpayments averaged $7.69. While overpayments are less common for brand-name drugs, the amount of the overpayments tends to be larger, averaging $13.46.

    Not surprisingly, 12 of the 20 most commonly prescribed drugs involved overpayments one-third of the time. The researchers question whether higher costs affect medication adherence and have a negative effect on health outcomes for people who cannot afford them.

    Note that the researchers were not able to analyze more recent data. Shockingly, it is proprietary. You have to wonder what else the insurers and pharmacy benefit managers are hiding. You also have to wonder why Congress does not require the full disclosure of this information for the public good. After all, taxpayers and Medicare are paying these bills.

    You should always ask the pharmacist about your drug’s cash price before paying the copay. The pharmacist must tell you if asked, and you could save a lot of money. If you have Medicare, you should know that if you go to an in-network pharmacy and pay a cash price lower than the copay, you can still submit the charge to your health plan. It will be counted towards your out-of-pocket expenses that put you in or get you out of the Part D donut hole.

    If you are struggling to pay for your drugs, you might consider buying your drugs online or abroad, as millions of Americans are now doing.

    And, if you want Congress to rein in drug prices, please sign this petition.

    Here’s more from Just Care:

  • Seven reasons commercial insurance cannot meet our health care needs

    Seven reasons commercial insurance cannot meet our health care needs

    As policymakers, pundits and the public consider the path to universal health care coverage in the US, it is helpful to remind ourselves of the key reasons that commercial health insurance cannot and will never meet our health care needs.

    Because, as a rule, commercial health insurers put profits before people:

    1. Commercial health insurers are generally unwilling or unable to disclose their benefits or deliver value for people with costly and complex conditions; rather, they tend to deter people with complex and costly conditions from enrolling or, if they are enrolled, from seeking care and remaining in their health plans.
    2. Commercial health insurers cannot offer reliable coverage and they undermine continuity of care. They are constantly changing the doctors and hospitals you can use, and they cannot guarantee that they will offer you coverage from one year to the next.
    3. Commercial health insurers may delay and deny care arbitrarily and keep their protocols and data proprietary, unwilling to be publicly accountable regarding their value to consumers.
      • To generate profits, they treat data as proprietary that would allow researchers to report whether they deliver high value cancer, stroke or heart care. Outside researchers and rating agencies generally cannot access the needed data or, if they can, cannot report on what they learn with respect to a particular health plan or on the comparative value of these plans when it comes to costly services. Try googling “best health insurance for people with diabetes.”
      • They may hire medical directors to oversee treatment decisions who do not understand the conditions or the treatments for which they are denying care, with little risk anyone will know.
      • They may deny coverage for ER visits, based on patients’ diagnosis, expecting patients to know when they really need emergency care and deterring them from getting needed emergency care.
      • They have a financial incentive to delay or deny care without fear of harming their brand image since consumers cannot compare their value in a meaningful way and they are unlikely to be held to account for these practices. Moreover, they have a financial disincentive to deliver high value cancer, stroke or heart care or to cover costly drugs to treat complex conditions or too many people with those conditions would enroll, jeopardizing their profits.
    4. Commercial health insurers are generally unwilling or unable to drive system change that promotes overall value to our health care system.
      • They are unwilling or unable to control high hospital rates. Rather, they shift costs to people who go to the ER unnecessarily by charging them the full cost of their visit rather than penalize hospitals for not having a cost-effective triage system for people who go to the ER. Medicare, in sharp contrast, penalizes hospitals with high readmission rates to incentivize them to discharge patients appropriately, rather than penalize patients who are readmitted.
      • They are unwilling or unable to control rising drug costs. It can be financially rewarding for health insurers to make profits off of higher-priced drugs (formulary with brand-name drugs and not generic alternative)  or to charge their members a higher copay than their actual cost for the drug.
      • They are generally unwilling to share their data. They tend to see anything they learn that’s working or not working as giving them a competitive edge, be it on the value of a medical device, drug or treatment or any other care-related item. For example, is there a health plan that alerts the general public to a particular treatment that causes their patients harm or provides unique benefits?
    5. Commercial health insurers engage in fraudulent practices.
    6. Commercial health insurers are unwilling or unable to rein in ever-increasing health care costs. Rather, they drive up costs through the time, money and personnel they require for billing and other insurance-related activities.
    7. Neither states nor the federal government have the resources to effectively oversee commercial health insurers and hold them accountable for their inappropriate or illegal activities.
      • Unlike commercial firms that create products whose systemic defects are fixed and can be detected, if not immediately, over the long term, commercial health insurers create products that are constantly changing–doctors, hospitals, protocols for approving and denying care, costs, etc.–and make covert decisions that are constantly changing–medical necessity and billing, etc. As a result, arbitrary denials and delays of care can easily go undetected.
      • All but a handful of states, if any, have the will, skill and resources to ensure that commercial health insurers are complying with their legal obligations and meeting the needs of consumers. And, the federal government does not oversee commercial health insurers outside of government programs.
      • Even with the will, skill and resources needed, health plan data is proprietary, so even independent researchers are hard pressed to report on the failings of particular health plans.
      • Except in the most egregious situations which come to public light, it is near impossible to develop measures to evaluate whether health plans are delivering on their obligations to consumers and not delaying or denying needed care, let alone delivering value or committing fraud.

    Improving and expanding Medicare to everyone is the best way to ensure all Americans have access to good, affordable care. If you support Medicare for all, please let Congress know. Sign this petition.

  • Don’t sign a bank loan in the hospital

    Don’t sign a bank loan in the hospital

    Shefali Luthra reports for Kaiser Health News on how unsuspecting patients are signing bank loans in the hospital in order to pay their hospital bills. Some hospitals are partnering with banks as a way to help ensure they are paid in full for their services. While that may be good for the hospitals, it may not be good for the patients.

    One insured patient, Laura Cameron, was approached by a hospital employee about taking out a loan while strapped to her gurney in the emergency room. Cameron reported that she was pressured to believe that her only choice was to take out the loan or immediately to pay the $830 she was told she owed out of pocket. Fortunately, she turned the loan down and did not pay the hospital right then, as her total out-of-pocket costs with insurance turned out to be $150.

    Advocates suggest that patients should not be signing up for these loans so quickly. The loans, which are often no interest or low interest may sound better than they are. The loans can be tempting because they are available without credit checks or affordability tests. But, you may not need the loan and could be paying the hospital more than you owe. The out-of-pocket costs for the hospital stay may be lower than the hospital suggests, with the insurer’s negotiated price, as was the case for Cameron.

    If you have traditional Medicare and supplemental insurance, you may not face this situation during a hospitalization since you should have no out-of-pocket costs. With a Medicare Advantage plan, there is a good chance that you have high out-of-pocket costs. But, beware. An increasing number of hospitals are partnering with financial institutions as a way to ensure that they are paid in full for the care they provide. Many people with insurance have such high out-of-pocket costs that they cannot afford to pay them. Right now, about 15-20 percent of hospitals offer loans to patients.

    Advocates argue that patients with low incomes should not need loans to cover costs their insurance does not pay. The hospital should offer them assistance or charity care.

    Here’s more from Just Care:

  • Congress must protect our community health centers

    Congress must protect our community health centers

    Every Thursday morning, I wake up excited for the 14-hour day I’m about to begin. My Thursdays are so long because that’s the day I work a second evening job at a Federally Qualified Health Center (FQHC) that serves New York City’s lesbian, gay, bisexual, transgender, and queer (LGBT+) population. Why am I so happy to work a longer day? Not because I am a glutton for punishment, but because the work is truly satisfying in the way that only feeling completely confident in the care I’m providing can make me feel.

    The FQHC I work at provides essential medical and mental health care to an often-vulnerable population. Beyond the stress of being LGBTQ+ in our society, the patients I see are mostly uninsured or on Medicaid. Many have HIV/AIDS, substance use problems, and/or significant mental illness. I see individuals from diverse backgrounds and all age groups, from trans youth struggling with histories of abuse or homelessness, to older gay men who survived the AIDS crisis and lost many loved ones. Each person comes with a painful yet inspiring story, filled with strength, resilience, and love.

    And the care provided at this clinic, like most FQHCs – also referred to as Community Health Centers (CHCs) – is not just “good for the safety net.” It is the highest quality; often better than many private practice settings on multiple quality measures. Why is this?

    First, the care is truly integrated. I share a single medical record and can easily communicate with my patients’ medical providers. This reduces the chances of errors and conflicting treatments, such as drug-drug interactions. Quality improvement initiatives from the medical clinic apply to the mental health clinic and vice versa.

    Second, as federally funded clinics that participate vigorously in the Medicaid program, CHCs are often the first to know about and participate in health systems improvements and innovations. Despite what some private providers might tell you, government does a lot more than add bureaucratic hurdles; it attempts to ensure that health care is delivered in a safe and equitable way, is informed by evidence and guidelines rather than idiosyncratic clinician ideas and habits, and is responsive to public health needs. For instance, CHCs were on the frontline during the AIDS crisis, and are now playing a similar role in responding to the opioid epidemic.

    Third, CHCs are often full of passionate, mission-driven clinicians who deeply believe in what they are doing and care about the populations they serve. At the CHC where I work, clinicians are constantly sharing recent evidence, clinical advice, and local resources relevant to the LGBTQ+ population. Wouldn’t you want to be cared for by a group of individuals who are passionate about serving you and continuously communicating about better ways to do so?

    Finally, CHCs specialize in providing high quality primary care, which has been shown to produce the best outcomes. They are beacons of well-coordinated, efficient medical care in our specialist-driven and siloed health care system. This translates to better care at a lower cost!

    There are more than 10,000 CHCs in the United States, providing care for about one in thirteen Americans (and an even higher proportion in some states). In addition to primary care and behavioral health (i.e., mental health and substance use) services, like those provided where I work, many CHCs also provide dental and vision care. For the reasons above, 86 percent of primary care providers at CHCs are satisfied with their work, and 73 percent of patients who use CHCs as their primary source of medical care feel that it is high quality.

    It is therefore not surprising that CHCs have long enjoyed strong bipartisan support. Regardless of your political leanings, CHCs are clearly a rare example of a great deal in American healthcare. However, during recent fights over funding the federal government that resulted in two brief shutdowns, the Community Health Center Fund expired on September 30, 2017, and was not reauthorized until February 9, 2018. The Continuing Resolution that reopened the government in January included funding for the Child Health Insurance Program (CHIP) but not CHCs.

    If Congress had not restored funding in the nick of time, the Department of Health and Human Services estimated that about a quarter of CHCs would have had to close, resulting in nine million people losing access to healthcare and 51,000 job losses. Many CHCs had already begun deferring important investments and delaying staff hiring.

    This barely averted tragedy has received far too little attention. Let’s not take our CHCs for granted ever again; let’s avoid this kind of near miss in the future.

    Here’s more from Just Care:

  • Two tips for keeping your emergency care costs down

    Two tips for keeping your emergency care costs down

    There were 451 emergency room visits for every 1,000 people in America in 2014, up more than 10 percent in the last decade. Medicare always covers emergency care. But, the ambulance trip and the emergency room visits can be very expensive if you are not prepared.  Here are two tips to keep your emergency care costs down.
    1. Find a local ambulance that your health plan covers and keep the number in a safe place.
      • If you have traditional Medicare, the government-administered program, find the number for a Medicare-certified ambulance. So long as you have supplemental coverage, your costs should be covered in full.
      • If you are enrolled in a Medicare Advantage plan, a commercial health plan that offers Medicare benefits, or any other commercial health plan, find the number for an in-network ambulance. Otherwise, your costs could be exorbitant. Unless your insurer has negotiated a price with an ambulance company, that company can charge what it pleases. No one controls the price of ground ambulance services. Kaiser Health News reports that patients in commercial health plans are increasingly facing sticker shock from the cost of their ambulance services.
      • If possible, avoid calling 911 for an ambulance because you may have no control over whether your insurer will cover the ambulance services or whether the ambulance will take you to an in-network hospital. Much like surprise medical bills that patients receive from out-of-network doctors who see them when they are admitted to their in-network hospital, bills from ambulance companies that are not part of a health plan’s network can be in the thousands of dollars. A January 2017 Health Affairs study finds that more than 125,000 of 500,000 ambulance trips in 2014 were out of network.
    2. Call your health plan to understand your out-of-pocket costs for emergency room care and what you can do to minimize them.
      • If you have traditional Medicare, Medicare combined with your supplemental coverage should pick up your costs.
      • If you are in a commercial Medicare Advantage plan, administered by a private insurance company, you will be covered for out-of-network care in an emergency for emergency room services. Your health plan cannot bill you more than $50 for those services. Medically necessary follow-up care is also covered when your health is endangered.
      • If you are not yet eligible for Medicare and enrolled in a commercial health plan, you are guaranteed some protections under the law; but, it is best to know your health plan’s rules.

    If Congress expanded Medicare to cover everyone in the US, as Senator Bernie Sanders and 15 other Senators have proposed, it would protect everyone from surprise medical bills, including surprise ambulance bills. For now, Representative Lloyd Doggett has introduced a bill that would protect patients from surprise medical bills.

    If you want Congress to expand Medicare to everyone in the US, please sign this petition.

    Here’s more from Just Care: