Never Fear a Surprise Bill Again!
As the new year rolls in, the “No Surprises Act” consumer protection law will go into effect. This legislation bans most unexpected medical charges from out-of-network providers.
At Altus Emergency Centers, we are thrilled about this news and applaud lawmakers’ efforts to protect patients from unfair charges.
As you all know, at Altus, we implemented a no surprise bill policy more than a year ago. Since then, none of our patients have received a surprise.
However, no matter how hard we try, we cannot control everything the insurance companies do. Unfortunately, some of them have unlawfully tried to charge patients for emergency services.
We want to help you know what to do in these cases, so you never have to fear getting the medical treatment you need.
What is a Surprise Bill?
A surprise medical bill is when you unknowingly receive medical care from a provider outside your private insurer network. For example, in many hospitals and emergency rooms, the specialists who treat patients are not employees but contractors who charge their fees separately. As a patient, you are not aware of this, which is why many people receive a bill they were not expecting after going to the ER.
What Will the Surprise Medical Bill Protections Do for You?
The protections will work similarly to those established by the state of Texas. The new federal rules will apply to all private insurers, even those provided through the Affordable Care Act.
With this new law, you should not receive a surprise medical bill from the following scenarios:
- When you get treated at the ER
- Air ambulance services (airplane or helicopter)
Insurance companies must also provide the same coverage regardless of whether you receive medical attention at an in-network or out-of-network facility.
The Law Has Always Been On Your Side
In a perfect world, your insurance company would be your best friend, always looking out for your best interest. But the reality is that insurers increasingly deny coverage for your emergency care.
If this should ever happen to you, please reach out to our Patient Advocate; we can help you get the coverage you are entitled to.
You should know that even before the “No Surprises Act” existed, the law already protected you through the Prudent Layperson Standard. This standard says that YOU get to decide when and where you seek emergency care based on your symptoms.
Your insurance company cannot force you to go to an in-network ER. They are also not allowed to determine if your symptoms were those of a medical emergency or not.
In other words, if you feel you are having a medical emergency and need to go to the ER, your insurance provider is legally obligated to cover your care.
Recent Updates on the No Surprises Bill As Per the CMS and What It Means to You
Recently, as per the Center of Medicare and Medicaid Services or CMS.gov, the provider and facility requirements that apply starting January 1st consist in the following:
- No balance billing for out-of-network emergency services
- No balance billing for non-emergency services by nonparticipating providers at certain participating health care facilities, unless notice and consent was given in some circumstances
- Disclose patient protections against balance billing
- No balance billing for air ambulance services by nonparticipating air ambulance providers
- Provide good faith estimate in advance of scheduled services, or upon request (for uninsured or self-pay individuals)
- Ensure continuity of care when a provider’s network status changes
- Improve provider directories and reimburse enrollees for errors
Find out more information on the background & purpose of the No Surprises Act of Division BB of the Consolidated Appropriations Act, 2021 (CAA) amended title XXVII of the Public Health Service Act (PHS Act) to add a new Part E through reading the High-Level Overview of Provider Requirements.
What to Do If You Receive a Surprise Bill
Here at Altus, you will never have a surprise bill!
All services provided at our facilities, including specialists and other ancillary services, will show in the invoice we provide you after your visit. Because we directly employ all our doctors, you will never see a big bill from us.
Should you ever receive a surprise bill from your insurance company after visiting one of our centers, please contact our Patient Advocate immediately.