‘No Surprises Act’ on Medical Costs Goes Into Effect January 1
Montana State Auditor and Insurance Commissioner Troy Downing called KGVO News this week to remind readers and listeners that the ‘No Surprises Act’ goes into effect on January 1.
Downing explained how the ‘No Surprises Act’ will help consumers deal with ‘out-of-network’ emergency bills that could potentially bankrupt a family.
“If you're in an emergency situation, and you go to a hospital for emergency treatment, and you have health insurance and let's say that hospital is in your network for your health insurance, but then they've got another party that is giving you care that’s not in your network, let's say an anesthesiologist,” began Downing. “What this does is it protects you from getting a balanced bill from that anesthesiologist who was outside of your network.”
Downing drove the point home that these surprise out-of-network bills can severely damage a family’s finances, or even lead to bankruptcy.
“There are a lot of people who have faced financial ruin or bankruptcy because of these large bills that they suddenly find themselves on the hook for,” he said. “So what the No Surprises Act does is that it protects you from having that what we call balance billing or those surprise bills coming from third parties.”
Downing was careful to differentiate between what the act covers and what it doesn’t cover.
“It's important understand what it is, but it's also important to understand what it's not,” he said.” “It doesn't allow you to just choose to use an out of network provider that's not protected under this bill. So if you by your own choice decide to use somebody out of your network that doesn't force your health plan to pay for that, because obviously that was your choice. Where this normally comes into play is when you have no choice in who's giving you care, and you don't know who all those people are down the line. Most commonly this is going to happen in an emergency situation.”
Downing said most often when these massive bills arrive, they are from the use of an air ambulance service.
“Having air ambulance service is also covered under the no surprises act so you can't get surprise billing or out of network bills from an air ambulance service,” he said. “It's one thing important to note is this does not cover traditional ambulance services. It just covers the air ambulance services, but I believe that the Biden administration is working on adding that in.”
Even though the bill goes into effect on January 1, Downing said the Biden health administration is attempting to add more exemptions to aid consumers.
Downing provided contact information to his office for anyone who may have questions or problems with payment of out-of-network medical bills.
“You can find us at CSImt.gov and as the information comes out we'll keep updating the website with the latest information we have there,” he said. “We're also at 406-444-2040 if you have questions.”
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