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IN DEC. No More Surprise Medical Bills

I got a surprise bill. What can I do about it?

Call the doctor or provider that sent the bill and discuss your concerns. In most cases, Texas law requires providers to provide an itemized bill on request, so review the charges carefully. Some providers might accept a lower payment. You can compare the amount you were charged to the average market price using TDI’s Health Insurance Reimbursement Rates Consumer Information Guide or websites such as NewChoicehealth.com,  FairHealthConsumer.org, and TxPricePoint.org.

Call TDI’s Consumer Help Line at (800) 252-3439 to discuss your options.

There are two main ways TDI can help: mediation (Texas law allows many consumers to seek mediation for bills that exceed $500) and complaints.

Info-graphic on Surprise Medical Bills – from the Center for Public Policy Priorities

Click the link below for more information.


Biden Nixes ‘Surprise’ Medical Billing Practices, a Common Problem In Portland Personal Injury Claims

When any type of accident results in personal injuries in Portland, it is important to seek medical care immediately. Potentially life-threatening conditions can have symptoms that appear subtle at first. Visiting the local hospital emergency room is the safest bet. Unfortunately, it can also leave you facing heavy medical bills due to ‘surprise’ charges for out-of-network care. The Biden administration recently took steps to put a stop to this practice.

New Rule Eliminates Surprise Medical Billing for Certain Policy Holders

Changes in federal law that take effect next year could provide increased clarity in medical billing while reducing the overall amount you pay for emergency medical services. According to a July 3, 2021 Wonkette report, the Biden administration recently issued an administrative rule that eliminates surprise medical billing for people with employer-provided health insurance coverage and for those who purchase plans on the private market. The new rule begins January 1, 2022.

What is surprise medical billing? As the name implies, it is when you are billed for unexpected charges related to alleged out-of-network care. It is a common problem for people who are victims of accidental injuries. The following provides an example of how it happens:

  • You are involved in a car accident due to recklessness on the part of another driver;
  • You bump your head in the crash, experiencing symptoms such as headache, blurred vision, and nausea;
  • After reporting it to the police and exchanging information with others involved, you rightly visit your local hospital emergency room;
  • You obtain treatments that are otherwise covered by your health insurance;
  • Weeks later, you get a bill for hundreds or even thousands of dollars, due to parts of your care that were deemed out of network and billed at a ridiculously high rate.

The ‘No Surprises’ Act

The new Biden administrative rule follows up on H.R.3630, known as the ‘No Surprises Act’. Passed by Congress in 2020, its goal is to put a stop to surprise medical billing practices and applies to a variety of services, including:

  • Ambulances and airlifts to hospital emergency rooms;
  • Emergency diagnostic testing;
  • Emergency medical procedures;
  • Anesthesiology services;
  • Other care or treatments provided by emergency room doctors or other staff.

The No Surprises Act bans insurance providers from billing any of these and other services as out-of-network and at higher rates, which has become an increasingly common practice as private equity firms take over providing health care. The Act still faces several hurdles before being officially enacted, but the Biden administration’s recent actions provide valuable support and temporary relief for people who require emergency medical care due to personal injuries.

Reach Out to Us Today for Help

Have you been left to face a hefty hospital bill as the result of personal injuries? The Johnston Law Firm P.C. is here to help you get the compensation you deserve. To discuss your options, call (503) 546-3167 or contact our Portland personal injury attorney online today.

HHS Announces Rule to Protect Consumers from Surprise Medical Bills

Today, the Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans.

“No patient should forgo care for fear of surprise billing,” said HHS Secretary Becerra. “Health insurance should offer patients peace of mind that they won’t be saddled with unexpected costs. The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises.”

Among other provisions, today’s interim final rule:

Bans surprise billing for emergency services. Emergency services, regardless of where they are provided, must be treated on an in-network basis without requirements for prior authorization.

Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates.

Bans out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances.

Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.

These provisions will provide patients with financial peace of mind while seeking emergency care as well as safeguard them from unknowingly accepting out-of-network care and subsequently incurring surprise billing expenses.

Tackling surprise billing is critically important, as it often has devastating financial consequences for individuals and their families. Two-thirds of all bankruptcies filed in the United States are tied to medical expenses. Researchers estimate that 1 of every 6 emergency room visits and inpatient hospital stays involve care from at least one out-of-network provider, resulting in surprise medical bills. And a 2019 study by the Government Accountability Office (GAO) found that the median price charged by air ambulance providers ranged from $36,400 to more than $40,000, and over 70% of these transports were furnished out-of-network, meaning most or all costs fell to the insured individual alone. Thanks to the Biden-Harris Administration and bipartisan congressional support, HHS, Labor, Treasury, and OPM are promulgating rules that will protect consumers from financial ruin simply because they could not ask for an in-network provider during their treatment.

“No one should ever be threatened with financial ruin simply for seeking needed medical care,” said U.S. Secretary of Labor Marty Walsh. “Today’s Interim Final Rule is a major step in implementing the bipartisan No Surprises Act that will protect Americans from exorbitant health costs for unknowingly receiving care from out-of-network providers.”

“Facing a difficult medical situation is challenging enough – no one should then face a surprise medical bill when they get home,” said OPM Director Kiran Ahuja. “This interim rule helps to protect Americans from financial ruin and honors federal employees, retirees, their covered family members and other enrollees who receive healthcare through the FEHB Program, the largest employer-sponsored plan, by giving them new protections from unexpected medical bills.”

Today’s interim final rule with request for comments implements the first of several requirements passed with bipartisan support in title I (the “No Surprises Act”) of division BB of the Consolidated Appropriations Act, 2021. The regulations issued today will take effect for health care providers and facilities January 1, 2022. For group health plans, health insurance issuers, and FEHB Program carriers, the provisions will take effect for plan, policy, or contract years beginning on or after January 1, 2022.

Fact sheets on this interim final rule can be found here and here.

The interim final rule with comment period can be accessed here.





Lead Attorney at Johnston Law Firm, P.C.
Based in downtown Portland, Marc A. Johnston is the owner and managing attorney of the award-winning, internationally-known personal injury law firm, Johnston Law Firm, P.C. Marc’s career has been dedicated to representing the injured and individuals who have been treated unfairly by an insurance company. His focus on trial law creates the backbone of the Johnston Law Firm — a firm that is ready to go the distance in seeking justice for its clients.

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