What is the No Surprises Act?
It is common for emergency physicians, anesthesiologists, radiologists, surgical staff, and others to work for independent companies that contract with insurers; they do not necessarily take the same insurance as the hospital. Until Jan. 1, 2022, these situations often resulted in patients receiving surprise medical bills from the providers of the services that required them to pay the balance—the difference between what the provider was reimbursed by the insurance company and the full amount of the provider’s bill (thus, “balance bills”).
On Jan. 1, 2022, the No Surprises Act took effect, which largely bans surprise balance bills. The No Surprises Act is part of the Consolidated Appropriations Act of 2021. The No Surprises Act removes the patient from liability and forces the provider and payer to resolve their price disputes. This change restricts surprise billing practices for any emergency service and for some non-emergency care, explains The Wall Street Journal.
Examples of surprise medical bills
Patients can encounter surprise medical bills in emergency and non-emergency medical situations. These bills are largely related to out-of-network charges. A patient incurs an out-of-network charge when they receive care from a facility or provider not covered by their insurance.
Patients may not realize that they are visiting an out-of-network facility or provider in a number of circumstances, including in an emergency situation, when a patient is taken to an emergency room out of their network, either without their knowledge, or because the out-of-network emergency room is the closest facility to them, or when a patient visits an in-network hospital, but is treated by an out-of-network doctor.
In both instances, patients do not have much of a choice about where or by whom they are treated, leading to surprise medical bills.
Patients around the country have encountered these issues, leaving them with costly medical bills. According to a Yale study “Surprise! Out-of-Network Billing for Emergency Care in the United States,” patients have an almost 1-in-4 chance that the ER doctor who treats them is out of network. This creates a confusing and costly situation for patients who are trying to go to in-network doctors and hospitals.
The problem was exacerbated by the COVID-19 pandemic, explains The New York Times. A woman suffering from coronavirus, intubated and on a ventilator, was flown by air ambulance between two in-network hospitals. Her family told The New York Times they are now facing a $52,000 bill for the service.
A Texas woman who needed medical care after contracting COVID-19 in 2020 told reporters that she faced a $4,000 bill for treatment she received in her in-network hospital from out-of-network doctors. Even after treatment, she reportedly was confused and suffered short-term memory loss, symptoms of COVID-19.
Are there exceptions to the No Surprises Act?
The No Surprises Act marks a significant change for many patients. However, there are some important exceptions to the law. Many patients may still receive surprise medical bills incurred in 2021 or earlier, as the rule does not apply retroactively, says NPR.
In addition, patients with high deductibles or who participate in a co-sharing health plan may see steep medical bills, as well as those that are treated by out-of-network providers for non-emergency issues.
The New York Times explains that the law makes an exception for ground transportation, meaning that you may still face medical bills for your emergency transportation to a medical facility. While ground ambulances are not currently covered in the No Surprises Act, the Biden Administration is in the process of examining how to stop patients being charges steep ground ambulance fees. According to The Washington Post, this gap in the regulations poses a serious cost issues for patients. Unlike ground ambulances, air ambulances are included in the No Surprises Act.
Do state laws protect against surprise medical bills?
Patients around the country may have additional protection against surprise medical bills, depending on their state of residence.
Texas: The Texas Legislature passed a landmark bill in May, 2019, to combat surprise medical bills. In June, 2019, Gov. Greg Abbott signed the bill, which made it illegal for emergency room doctors to charge patients for the portion of the bill the insurance company doesn’t cover, according to NPR. In addition, Texas patients are protected from balance billing by out-of-network doctors when patients don’t have any control over who treats them at an in-network hospital.
Georgia: The Georgia Senate passed legislation in February, 2020, with the goal of limiting surprise medical bills, according to the Atlanta Journal-Constitution. The Georgia legislation specifically addresses insured patients who go to an in-network hospital.
California: In California, the fight against surprise medical bills has been challenging. In February, 2019, California Assemblymember David Chiu and Sen. Scott Wiener introduced Bill A.B. 1611 to end emergency room surprise billing by prohibiting hospitals from charging patients any more than their copays or deductibles if they are treated at an out-of-network hospital. This legislation is designed to protect patients if they have an emergency in which they have no control over where they are treated.
Although A.B. 1611 was passed in May, 2019, it sat in Senate until ultimately withdrawn in July, 2019. Assemblymember Chiu issued an official joint statement shortly after the withdrawal, claiming that the decision to pull A.B. 1611 was due to “lobbyists and CEOs . . . [who] have made it abundantly clear that they will protect [surprise billing] profits over patients” and the “insurmountable” moneyed opposition.
Regardless of the withdrawal of A.B. 1611, consumers have continued to seek justice when it comes to unfair surprise billings.
In June, 2020, a judge in the U.S. District Court for the Central District of California approved a class action settlement after a complaint was filed against Envision and EmCare for unfairly charging patients with out-of-network costs at an in-network emergency room.
Join a surprise medical bill lawsuit investigation
Patients who received surprise medical bills from an out-of-service hospital, ambulance, or another medical service may be able to join a class action lawsuit.
Unfortunately, most large companies that hire physicians to work in various hospitals do not bill under their names — they generally bill under the name of the physician group for that hospital — so it can be difficult to determine if you went to an emergency room run by a large company.
The attorneys handling this class action investigation can help you determine your eligibility. Simply fill out the form on this page for a free evaluation.
If you were hit with a surprise medical bill from an out-of-network doctor at an in-network hospital or other medical facility you may qualify to join this surprise medical bill class action lawsuit investigation.
Get help now by filling out the form on this page for a FREE case evaluation.
