What is a Surprise Medical Bill?
As the name denotes, Surprise medical bills are the unexpected bills that a patient gets after being provided with the medical services they require. Simply put, a surprise medical bill is an unforeseen bill, usually for services acquired from an out-of-network healthcare physician or facility that you were unaware of until you were invoiced.
The No Surprise Billing Act is a brand-new piece of legislation that came into being at the beginning of 2022 to protect Americans from receiving unexpected invoices. The act would stop the practice of balance billing, which is when patients are charged for the difference between what their insurance covers and what the practitioner charges. This practice would no longer be allowed now that the act has passed.
In this piece, we will discuss how the No Surprise Billing Act would safeguard millions of Americans’ finances by prohibiting sending unexpectedly high bills at the end of the year. We will also discuss how this law can help save lives by ensuring that no one is denied access to vital medical treatment.
What is the NSA, and how does it protect Americans from surprise medical bills?
The No Surprises Act (NSA) forbids invoices from an out-of-network provider for a visit to an emergency room or other in-network institution that the patient did not select or was unable to. The NSA guards patients against unexpected or so-called “balance” bills from out-of-network medical professionals at hospitals or other facilities that are in-network.
Due to the NSA, providers and health insurers now have a procedure to settle differences over the legislation. Additionally, it gives patients the option to make a complaint.
The act aims to prevent patients from receiving unexpectedly high medical bills for procedures not covered by their insurance network. The measure would ban insurers from sending patients a balance bill for services provided by doctors not in their network and would compel them to provide greater transparency regarding whether providers are in-network.
The No Surprise Act has received support from various consumer and patient advocacy groups and endorsements from insurers and providers of healthcare services. In the past, patients lacked the security against unforeseen medical expenses that would be afforded to them by the No Surprise Act.
Healthcare providers are dedicated to helping people, even if it costs them a lot. They need to remember that the business side of their practice is also important if they want to keep their doors open. There are disagreements about payments from the government and businesses amounting to billions of dollars. Reliable medical billing companies that offer radiology billing services also offer medical services as per your specialties can help stop the flow.
Who exactly is protected by the No Surprise Billing Act?
Because of the No Surprise Act, citizens of the United States are protected from being taken aback by unexpected medical expenditures. This would be accomplished by:
- Prohibiting patients from being charged a debt for emergency care received in facilities that are not part of their insurance network.
- Requiring insurance providers to disclose more information about the networks, features, and prices they offer.
- Preventing healthcare providers from billing patients at rates higher than those charged inside a network for non-emergency care received outside of a network.
- Millions of people in the United States would be spared the stress and strain of unexpectedly high medical costs because of this act’s provisions.
Survey shows millions of bills already prevented—many more than anticipated
Policymakers and legislators may have underestimated the law’s effectiveness. The U.S. Departments of Health and Human Services, Labor, and the Treasury anticipated 17,000 claims to be filed in October 2021. Recent studies show that their estimates were too low.
Based on a recent analysis by Blue Cross Blue Shield Association (BCBSA) and AHIP, a national association whose members provide health care coverage, services, and solutions, more than two million unexpected medical bills for all commercially insured patients were avoided thanks to the NSA in the first two months of 2022.
Even if only a small percentage of these disputes were filed for resolution, the total would still surpass the government’s estimate. More than 12 million unexpected expenses might be averted by the end of 2022 if current trends hold.
Since surgery is multidisciplinary, surprise billing is common. Anesthesiologists and pathologists may bill a skin lesion biopsy patient. Postoperative billing surprises may arise. Surgical assistants—nurses, physician assistants, or other surgeons—can also bill patients for surgery with an in-network surgeon. A national database of privately insured patients found that 1 in 5 elective surgeries with an in-network surgeon resulted in an out-of-network bill. Anesthesiologists and surgical assistants typically caused these surprise bills, which averaged over $2000.
Surprising surgery bills can be especially harmful because patients cannot avoid them. They can choose an in-network surgeon and hospital, not anesthesiologists or surgical assistants. If the surprise bill had been anticipated, the final out-of-pocket cost might have influenced a patient’s decision to have elective surgery.
Surprise billing can irreparably damage the trust between patients and surgeons, more than just financially. This may make patients distrust surgeons and resist needed surgeries. A breach in this sacred bond between patient and physician could reduce patient trust in the medical system. Recent concerns about patient experience and the delivery system are poorly understood.
To what end does the No Surprise Act serve, and what are some of its benefits?
The No Surprise Act would end the practice of balance billing, when customers are charged for the difference between what their insurance company has paid and the full amount the provider has charged for their services. Patients would be shielded from unanticipated out-of-pocket expenses and assured that they would only be charged their in-network rate for services if this were the case.
In addition, the No Surprise Act would mandate that health insurers provide consumers with more information regarding their coverage and the costs they anticipate incurring for services. Patients would benefit from this since it will assist them in making educated decisions on their healthcare and help them avoid unpleasant shocks in the future.
In general, the No Surprise Act would offer people the much-required security they require against unforeseen costs associated with medical care. Additionally, it would assist in developing an overall healthcare system that is more open and equitable.
Is there anything about the No Surprise Act that could be considered a disadvantage?
The No Surprise Act is an excellent strategy to safeguard oneself against unanticipated financial obligations at the end of the year. There are a few downsides to carrying out this deed. First, it is important to note that this provision only applies to those “essential health benefits” specified in the Affordable Care Act. This implies that even with health insurance, you can still be accountable for unexpectedly high medical bills if your policy does not cover some fundamental needs.
In addition, the No Surprise Act does not protect consumers against all forms of unexpectedly high invoicing. For instance, if you travel to a hospital that is part of the network but is treated by a doctor who is not part of the network, you may still be responsible for paying the entire amount. In conclusion, the No Surprise Act does not apply to any invoices other than those due at the year’s end. This indicates that even if you have a bill due in the middle of the year, you can still be accountable for paying the total amount due on the bill.
Keeping healthcare affordable
Reduced surprise bills are part of a bigger effort to make healthcare more affordable. Blue Cross and Blue Shield organizations are attempting to improve affordability countrywide, by connecting what doctors are paid with the quality, not the quantity, of care they offer to employ technology to identify patients who may need extra support to stay healthy and prevent more expensive care.
Why is outsourced medical billing essential with the No Surprise Bills Act?
With the No Surprise Bills Act recently coming into effect, outsourcing medical billing services is more important than ever. This act protects patients from being charged more than anticipated for out-of-network care. To make sure that your patients are not surprised by their bills, it’s essential to have a good medical billing service in place.
A good medical billing company such as Medcare MSO will work with your patients to ensure they understand their bill and are not surprised by any unexpected charges. They will also work with your insurance company to ensure all necessary paperwork is filed correctly and on time. This can save you a lot of time and headaches down the line. Overall, outsourced medical billing is essential in today’s healthcare landscape.
Some of the benefits that come along once you outsource your billing to Medcare MSO:
- You Can Ensure Compliance With Regulations
- Billing issues will be addressed by a medical billing service.
- Individualized billing solutions for all types of medical facilities
- Allowing you to concentrate on patient care while we expeditiously submit your claims.
- All of Your Patients’ Data Is Secure
Medcare MSO is known for its devoted decade of experience in the medical billing company. The company has been healthcare practitioners and institutions with their RCM. Our expert medical billers and coders are well trained that will work tirelessly to get you the maximum reimbursement. We specialize in the following fields:
We hope this article has helped explain how the No Surprise Act safeguards millions of Americans from receiving unexpected bills at the end of the year. We acknowledge that this is a complicated matter; however, we are confident that the imposed legislation will go a long way toward assuring that patients will not be taken aback by astronomically high medical expenses they had not anticipated. If you have any queries regarding this matter, please do not hesitate to contact us; we would be more than delighted to assist you.
Isaac Smith is a highly accomplished healthcare professional with over 13 years of experience in healthcare administration, medical billing and coding, and compliance. He holds several AAPC specialty certifications and has a bachelor’s degree in Health Administration. He previously worked at a large multi-physician family care and occupational health practice with two locations in northwestern PA.
He now works for Medcare in the ICD-10 Editorial department to write articles about medical coding. He enjoys sharing his knowledge and experience as a certified PMCC instructor. He has authored many articles for healthcare publications and has been a featured speaker at workshops and coding conferences across the country.