5 Ways You Might Still Get a Surprise Medical Bill

Irina Baranova

Even with the new legislation, there’s still a chance you could accidentally wind up with a surprise medical bill as hospitals and providers adjust to the new rules, says Pollitz at the Kaiser Family Foundation. Here’s what you can do if that happens.

Don’t automatically pay it. Instead, start making calls, Pollitz says. First, contact your insurance company to find out whether the provider has submitted the bill to it yet. If it hasn’t, call the provider or hospital and remind it to submit the bill directly to your insurer. Once it has received it, your insurer should send you what’s known as an EOB, or Explanation of Benefits, that will include the in-network cost-sharing amount you owe for this service. The out-of-network provider is not allowed to bill you for more than that amount, says Pollitz.

Get an itemized bill and look for errors. If the amount you owe still seems high or is unaffordable, ask your insurer for a bill that itemizes the services you received. Look for duplicate charges or charges for procedures, tests, or services you did not get. Report errors to your insurer and the hospital or doctor’s office. It’s estimated by the Patient Advocate Foundation that up to half of all medical bills contain significant errors.

You can also compare the average cost for specific procedures in your ZIP code by looking them up in the healthcare bluebook.org (once there, select the free online tool). Knowing those costs can help you negotiate the bill down further.

File a federal complaint. The new law establishes a national consumer complaint system for surprise medical bills. If you’ve received a surprise medical bill in 2022 that you believe is in error, and you can’t resolve it with the healthcare provider or your insurer, you can file a complaint online or call 800-985-3059 between 8 a.m. and 8 p.m. EST, seven days a week. 

Have your medical bills and your insurer’s explanation of benefits and any other supporting documentation ready because you may be asked to provide those as well. While the federal complaint system cannot negotiate your medical bills, it can enforce federal laws, which could, in effect, lower or eliminate your payment.

File a complaint with your state. Thirty-three states have also enacted legislation that, to varying degrees, protects consumers from surprise medical bills. If you are having trouble getting relief from a surprise medical bill you believe to be in error, file a complaint with your state’s Consumer Assistance Program. Here you can find contact information for your state.

You may have special protection if you are uninsured. Under the new law, if you are uninsured, healthcare providers must now provide you with a “good-faith estimate” of what they will charge for your care. And if the final bill is $400 more than that, you can file a complaint with the Centers for Medicaid and Medicare Services. Once you file, the provider can’t send the bill to collections or charge a late fee until the dispute is resolved.

Get help. Go to the website for the Patient Advocate Foundation, a nonprofit group that helps people deal with unaffordable medical bills free of charge, or call it at 800-532-5274. And to learn more about your rights under the new law, go to Ending Surprise Medical Bills, a website maintained by the Centers for Medicare and Medicaid Services.

https://www.consumerreports.org/medical-billing/ways-you-might-still-get-a-surprise-medical-bill-a1086581623/

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