TOPEKA, Kan. (WIBW) – The new year brought additions to a law meant to keep you from getting huge medical bills you didn’t expect.
The federal government estimates up to 10 million hospital bills a year could be impacted by new protections in the No Surprises Act.
Ron Campbell, director of clinic revenue cycle for Stormont Vail Health in Topeka, says the changes help patients know what to expect.
“We want to make sure that the patient’s given the choice up front, and understands where they’re in network, where they’re out of network, and we get the patient to the right place up front before the surgery ever happens,” he said.
Congress passed the No Surprises Act in 2020. By last year, hospitals had to post a list of full prices for services and procedures. Starting January 1 this year, the law bans billing out-of-network rates without a patient’s prior approval; bans out-of-network charges or balance billing for services at in-network facilities; and people who are uninsured or not using their insurance must receive a good-faith estimate of what they will be charged.
“For example, you might go in for surgery and you’re billed by the hospital and by the surgeon, but you also receive a bill from maybe an anesthesiologist or another doctor in the group, and if that anesthesiologist wasn’t in-network for you, you might be billed more than you otherwise would have expected it to be. The bill prohibits that kind of billing,” Campbell explained. “I think it takes some of the concern and some of the risk out of situations where the situation is outside of their control. If I’m brought into an emergency room, for example, I have no control over who I’m being billed for; I have no control over who sees me. The Act removes those components from the situation and says, in an emergency situation, you can’t be balance billed because you never had a choice.”
Campbell says the changes will give patients information they need to be proactive.
“Ask those questions ahead of time and certainly we would know whether or not you’re going to be out of network and can walk you through those decisions ahead of time,” he said.
Stormont Vail has further information about the No Surprises Act available on its web site, www.stormontvail.org. The Centers for Medicare and Medicaid Services also has a full overview of the Act and resources for consumers at www.cms.gov/nosuprises.
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