People with traditional Medicare never receive surprise medical bills because doctors are not allowed to bill them directly for services they receive, except in the rare instances in which they have agreed in writing to be billed. But, nothing prevents doctors from billing people with private insurance coverage for their services, until now. Congress just passed a law forbidding out-of-network doctors from billing patients with insurance for their services.
So, what if you receive care at an in-network hospital and a group of out-of-network doctors treats you? The new law, which is part of the latest Congressional COVID relief bill, requires doctors and hospitals to duke out billing issues with insurers directly and prohibits them from billing patients, even when these providers are out of network. It is illegal for doctors and hospitals to bill you for out-of-network services.
The new law should help millions of Americans, as about one in five Americans end up receiving surprise bills today. The average surprise bill for people who visit the hospital emergency room is more than $600. In some cases, patients have gotten bills for more than $100,000.
Some corporations who own medical practices have made a fortune off of surprise bills. They buy up medical practices, have the doctors go out of network, and charge enormous fees for their services.
Fortunately, Republicans and Democrats in Congress agree that this practice must stop, as do the overwhelming majority of their constituents. Already many states do not allow surprise medical billing. It is about time that Congress stepped in on behalf of every American, even though some doctors and hospitals are not happy about losing revenue.
What’s totally insane about the Congressional legislation? It doesn’t take effect for another year, and it excludes ground ambulance services. It does cover air ambulances.
So, watch out. If you end up in a network hospital in 2021, tell the hospital that you only want to be seen by doctors in your insurer’s network. It could help you from receiving surprise bills.
Beginning in 2022, if doctors and insurers can’t agree on a rate for out-of-network services, they can take the issue to arbitration. The arbitrator will base a decision on the typical commercial rate for the services.
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