Local watchdog agency says law guarding against surprise medical billing may not be cure-all

Irina Baranova

HAMPTON, Va. (WAVY) — The staff at the Patient Advocate Foundation (PAF) are keeping a close watch for any potential surprises resulting from a new law designed to eliminate them.

The three-month checkup for the No Surprises Act shows that it’s working well in most areas, but the national watchdog PAF says certain problems are showing up that require closer attention.

No Surprises was signed into law by President Donald Trump and went into effect at the beginning of this year.

“Before the No Surprises Act, if you were in an in-network hospital, there was still a good chance that you would receive a bill from an out-of-network provider without even knowing it,” said Caitlin Donovan, senior director for PAF. She says for the vast majority of cases, it’s been a remedy for patients getting higher bills from out-of-network specialists — even when they were in a hospital that was in their network.

“[Under the new law] any ancillary services — things like radiology, anesthesiology, even neo-natal care, they cannot balance bill you or surprise bill you,” Donovan said.

It also covers a case where you need emergency care and the nearest hospital is not in your network.

“If you go in for an emergency to an out-of-network facility and they stabilize you, they can’t just start billing you like an out-of-network provider after that. They have to give you the option to transfer to an in-network facility,” Donovan said.

So far, so good, but all is not well with the No Surprises Act.

“I have heard news that different hospital systems declaring that they’re no longer going to provide out-of-network service for certain types of plans. There was a group in Ohio that did that,” Donovan said.

And Donovan says there’s more fallout from No Surprises.

The largest provider network in Mississippi has ended its agreement with the state’s largest insurer, Blue Cross Blue Shield. Donovan says long-time patients, as well as pediatric and neo-natal cases, are being told to go elsewhere and if more providers are successful in fighting the new law — patients will likely see higher costs.

So what happens if you’re getting care from a provider who’s in your network and they drop out of the network? Under the new law, you must continue to get the in-network rate for 90 more days. That provision applies to the people in Mississippi who must now find a different in-network health system.


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