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Surprise medical billing was supposed to end. Why it's still happening....

There are holes in the law that allow for out-of-network urgent cares and labs to still bill you.

GREENSBORO, N.C. — No one likes surprises, especially when it’s a medical bill totaling hundreds, even thousands of dollars. Unsuspecting consumers have complained about them for years, and now there’s a new law that should help. Like most laws, there are some loopholes. 

January 1, 2022, not only ushered in a new year, but it also brought the No Surprises Act, which addresses a problem millions of people with private health insurance face every year: surprise medical bills.

"For most people, the No Surprises Act means they’ll no longer receive an unexpected medical bill after being treated by a doctor or going to a medical facility they didn’t choose in the first place," said Lisa Gill, Consumer Reports Investigative Reporter. 

That's right: No more surprise bills from emergency room doctors or other out-of-network hospital providers like anesthesiologists and radiologists when you get care at an in-network facility.

The Kaiser Family Foundation estimates the No Surprises Act will apply to as many as 10 million surprise medical bills every year!

While all of this sounds great, the law still has some glaring holes. Take urgent care facilities: visits are covered only if the facility is licensed as an emergency service provider. But how do you know that?

"It’s best if you prepare ahead of time and call several in your area to ask if they’re licensed to provide emergency medical services," said Gill. For example, Google the urgent cares near you. Think of which one you would go to or have gone to in the past when care was needed. Then confirm that urgent care is in-network. 

And then there are lab tests at your regular doctor’s office. Be sure they use a lab that’s in-network. Again, do your homework before to avoid surprises.

Because the law is new, hospitals and providers are still adjusting to the new rules, which means they could accidentally send you a medical bill.

If that happens, contact your insurance company to see what’s going on. And be prepared to call your provider, because you might have to resubmit your claim for full coverage. If that doesn’t work, you can file a federal complaint online at cms.gov.

If you need further help with a surprise medical bill, contact the Patient Advocate Foundation, at patientadvocate.org. It may be able to help you deal with unaffordable medical bills.


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