The “No Surprises Act” – Does it Really Protect Patients from Unexpected Bills?

After years of debate, Congress passed a piece of legislation as part of its 2020 omnibus spending bill known as the “No Surprises Act,” or NSA. This law took effect on January 1st, 2022, and is intended to protect patients from being billed for some out-of-network medical care they receive without their knowledge. While this law does offer many important patient protections, it does come with some caveats that patients should familiarize themselves with. Read on for an analysis of the NSA from the elder law specialists at Slutsky Elder Law.

Protections Offered by the No Surprises Act

Prior to the passage of the NSA, about one in five emergency room visits resulted in a surprise bill. These surprise bills often resulted from medical care the patient received from an out-of-network doctor while visiting an in-network hospital. In most cases, patients were referred to specialists working at their in-network hospital without being informed that their services would not be covered by insurance. Weeks later, these patients would receive an extra bill for all services not covered by their insurance.

The NSA is intended to prevent these situations by ensuring that patients are always informed about the status of any doctor they receive care from while at an in-network hospital, giving them the opportunity to decline care from out-of-network doctors and shop around for medical care providers that are in their insurance network. If they receive out-of-network care without their knowledge, the Act stipulates that they cannot be billed more than the in-network rate for those services.

Gaps in the No Surprises Act

The passage of this legislation was significant, as it offers a great deal of protection that patients would not have otherwise received. It does, however, leave healthcare providers some wiggle room to bill patients for out-of-network services without informing them. Here are some examples of gaps that are present in the NSA:

  • Those receiving care at in-network hospitals are covered; the law does not apply to doctor’s offices, birthing centers, and urgent care clinics.
  • Air ambulance services are covered; ground ambulance services are not.

This means that while your next hospital visit will be covered by the NSA, your next doctor visit or urgent care visit will not be. You can receive services at the negotiated rate, but some services, like lab work, may not be covered even if they are conducted in the same building during the same visit.

An out-of-network doctor may also present you with a “Surprise Billing Protection Form” and ask you to sign before any services are rendered. In reality, signing this form waives your right to protection from surprise billing under the NSA. Any such form should also include a good faith estimate of the cost of your medical services, and the billed amount cannot exceed $400 over this amount. It is also illegal for some providers to present you with this form. These include emergency room doctors, anesthesiologists, radiologists, assistant surgeons, and hospitalists. If any of these professionals would refuse service to you because you won’t sign the form, it is important that you document the fact that you are signing under duress.

Protecting Yourself from Surprise Medical Bills

While the NSA is an important step forward in protecting patients from surprise bills, it leaves much to be desired. Because medical debt is the number one cause of bankruptcy in the United States, it is crucial that patients stay informed about the contents of the NSA and the ways in which medical providers may try to get around it. Seniors are especially vulnerable to surprise billing as they are more likely to need the type of specialized care that an out-of-network doctor would provide in a hospital setting.

Elder Law Attorneys in Montgomery County, PA

Medical care, especially skilled long-term care in a nursing facility, is the biggest threat to a senior’s financial well-being today. The team at Slutsky Elder Law works every day with seniors to ensure their legal needs are met. We can advise you on a range of legal topics including Medicaid asset protection, estate planning, guardianships, and more. Get in touch with us today if you need an elder care attorney in Montgomery County, PA, or anywhere else in the area.

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