EYEWITNESS NEWS (WBRE/WYOU) — A 2018 survey found that 57 percent of U.S. adults received an unexpected medical bill that they thought would be covered by their insurance.
A new law hopes to protect millions of Americans from these surprise bills. The No Surprises Act went into effect New Year’s Day to address the burden of unexpected medical bills.
Surprise billing occurs when a patient with private insurance receives an unexpected bill either in an emergency situation or when a service in an in-network facility is provided by an out-of-network provider.
The No Surprises Act requires insurance companies to cover surprise out-of-network costs in which the patient had no choice or control over their care.
Len Costello of West Pittston says he received an unexpected bill for $970 after getting stitches on his hand at an in-network emergency room. Costello says he already paid the copay.
“They tried to bill me on top of what I paid. Almost the same amount for a physician’s fee, saying it was an out-of-network physician. I mean when you’re there bleeding and you’re in pain, you’re not going to ask, ‘is this an in-network physician?’ you just assume that they are because it’s your emergency room,” Costello said.
Costello says after a year of trying to fight it, he filed a complaint through the attorney general’s office and the billing company finally closed the account.
The No Surprises Act also removes the patient from disputes between payers and providers. According to the Department of Health and human services, state approaches to settling payment disputes have led to increased health care costs in some cases.
The approach taken in the No Surprises Act is expected to lower overall health care costs.