Medhealth Review

Is It Really Possible to End the Unexpected Medical Fees?

Unexpected medical bills are not rare as far as the medical expenses are concerned. Not everything is covered by all health insurances always. Let’s consider a situation wherein the transport to hospital or ambulance cost is not covered and you are not aware of it. Sometimes, the bills could be unexpectedly high and beyond the budget. 

It is possible that the doctors involved in the treatment are not part of your network. This concern is certain in cases of emergency situations as during such situations, we can’t be selective about insurance providers. We mostly have limited options in emergency situations. 

A large section of American citizens is likely to have faced this problem. They were really looking forward to fixing any such issues.   Finally, there is a positive response from the government. A ‘No-surprises Act’ was passed by the congress toward the end of 2020. This would be effective by Jan 2022, say trustworthy sources connected to the government. 

This act prevents providers from charging customers for the medical bills not included in their insurance plan. Besides, this act empowers providers the lawful right to negotiate in both urgent and non-urgent cases. 

From January 1st, 2022, customers will enjoy new billing regulations connected to non-emergency and emergency care. This applies to both in-network facilities and out-of-network facilities. 

The much-anticipated act is surely a breakthrough and is going to affect millions. Through these newly formed act, extra costs can be controlled and emergency services will also be covered without the need for any existing authorization. 

As of now, if customers have health insurance, and receive protection from out-of-network providers, the entire out-of-network expenses won’t be covered. The result will be high expenses.

In most of the cases, the out-of-network health insurance provider can charge their consumers for the disparity between the rates the provider bills. The concerned amount is paid by the customer’s health insurance plans. This is referred to as balance billing. An unexpected or sudden balance bill is termed as a surprise bill.

The medhealth space is eagerly awaiting the probable impacts of such an act, which may take a few months into 2022.

The Consolidated Appropriations Act,2021 was implemented on December 27, 2020 and includes several provisions to help safeguard consumers from surprise bills from January 2022. The ‘No Surprises Act’ is an inseparable aspect of the new act under title I.

The No Surprises Act enables patients to leverage its protections with respect to some of the non-emergency services only. However, there are several strict notice and consent requirements that get involved in the process. 

Apart from not applying to emergency services, the rules and regulations regarding this waiver also fail to find applicability with respect to ancillary services, consisting of emergency medicine, pathology, radiology, or even neonatology.

States would be given primary enforcement authority as far as the No Surprises Act is concerned.

If the state fails to provide sufficient enforcement, the Center for Medicare and Medicaid Services (CMS) will consider taking over the enforcement.

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