No Surprises Act....every RV'er needs to understand this new law.

Vladimir · February 18

The last year of the Trump Administration the No Surprises Act passed Congress.

It is worthwhile for RV'ers to understand the law. It provides protection from "surprise medical costs", particularly for emergency care. It puts limits on hospitals and medical communities on HOW they charge for medical care without prior disclosure.

See this thread for my adventures with the medical system over $51.

It turns out that my medical provider, simply made my doctor "out of network" for a physical IF there was a Medicare coverage. They actually set up TWO addresses for my doctor. One in network and one outside network and billed to maximize their revenue flow.

With the No Surprises Act, they HAVE to tell me PRIOR to my appointment that for the purposes of my annual physical, I was "out of network".

Well, that ended the scam. Nobody would agree to a insurance plan where being "in-network" or "out-network" is a event designed to maximize revenue to the medical facility.

Everybody, should read the No Surprises Act and understand it. There are news reports that some medical providers are NOT following the law.

Here is a brief synopsis from the other thread.

Anyway here is some text from the government on the Act.

What are surprise medical bills?

Before the No Surprises Act, if you had health insurance and received care from an out-of-network provider or an out-of-network facility, even unknowingly, your health plan may not have covered the entire out-of-network cost. This could have left you with higher costs than if you got care from an in-network provider or facility. In addition to any out-of-network cost sharing you might have owed, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid, unless banned by state law. This is called “balance billing.” An unexpected balance bill from an out-of-network provider is also called a surprise medical bill.

People with Medicare and Medicaid already enjoy these protections and are not at risk for surprise billing.

What are the new protections if I have health insurance?

If you get health coverage through your employer, a Health Insurance Marketplace®,[1] or an individual health insurance plan you purchase directly from an insurance company, these new rules will:

Ban surprise bills for most emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).

Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.

Ban out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of a patient’s visit to an in-network facility.

Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections (i.e., you must receive notice of and consent to being balance billed by an out-of-network provider).

Kirk W · February 18

The No Surprises Act went into force Jan. 1, 2022 and applies to everyone. If people have not done so, it would be worthwhile to read some of the summary articles about the effects of it and what it does for us. I will link 2 of my favorites.

USC-BROOKINGS SCHAEFFER ON HEALTH POLICY ~ Understanding the No Surprises Act

Starting January 1, 2022, it will be illegal for providers to bill patients for more than the in-network cost-sharing due under patients’ insurance in almost all scenarios where surprise out-of-network bills arise, with the notable exception of ground ambulance transport. Health plans must treat these out-of-network services as if they were in-network when calculating patient cost-sharing. The legislation also creates a new final-offer arbitration process to determine how much insurers must pay out-of-network providers. If an out-of-network provider is dissatisfied with a health plan’s payment, it can initiate arbitration. The arbitrator must select between the final offers submitted by each party, taking into consideration several factors including the health plan’s historical median in-network rate for similar services.

Georgetown University| Center on Health Insurance Reforms THE NO SURPRISES ACT

As part of a year-end deal in 2020, Congress enacted the No Surprises Act, a new law that protects patients from surprise medical bills. These comprehensive new protections went into effect in 2022 and protect patients from surprise medical bills for emergency services (including air ambulances) and non-emergency services provided at an in-network facility. Patients’ out-of-pocket costs will be limited to the costs they would have paid if they had received services from an in-network doctor, hospital, or other health care provider.

Although many states(Opens in new tab) have protected patients from surprise medical bills, federal legislation was necessary to fill gaps in state authority and extend similar protections to the more than 135 million people estimated to be covered by employer self-funded plans.

Here are some resources to help better understand this historic new law and what it means for policymakers, patients, and industry stakeholders.

Ray,IN · February 18

I thank both of you Derek and Kirk! That is valuable information, on which everyone should school themselves.

Kirk W · February 19

3 hours ago, Ray,IN said:

I thank both of you Derek and Kirk!

It was Vladimir who made the first post and started the subject.

Edited February 19 by Kirk W

TXiceman · February 19

This was enacted Jan 1, 2022. Biden was President, not tRump.

Ken

rpsinc · February 19

1 hour ago, TXiceman said:

This was enacted Jan 1, 2022. Biden was President, not tRump.

Ken

When was the legislation created and voted in? I see that it was enacted in 2022 but what is the back story?

Second Chance · February 19

7 minutes ago, rpsinc said:

When was the legislation created and voted in? I see that it was enacted in 2022 but what is the back story?

Congress passed it as part of the Consolidated Appropriations Act of 2021.

Rob

Chalkie · February 19

12 minutes ago, Second Chance said:

Congress passed it as part of the Consolidated Appropriations Act of 2021.

Rob

Which was signed into law on December 27, 2020 by Trump before Biden took office on January 20, 2021.

Something I have noticed that starting this year every time we visit a doctor we have to sign a form acknowledging that our treatment is in-network. Could this somehow be a provision of that law? Maybe.