Have you ever experienced getting a surprise medical bill resulting from an emergency or for non-emergency services from an out-of-network facility, ambulance, or provider—even when you have a job-based or other health insurance plan? You find yourself billed for the differences in costs. Maybe you’ve even experienced foregoing care over concerns about an out-of-network surprise billing.
If so, help is on the way. Thanks to the July 1, 2021, interim final rule, “Requirements Related to Surprise Billing; Part 1” issued by the U.S. Departments of Health and Human Services, Labor, and Treasury and the Office of Personnel Management, billing practices will be changing.
People with coverage through most government programs like Medicare, Medicaid, Veterans Affairs, or TRICARE already have safeguards from “surprise billings.” Protections will expand to insurance obtained through your employer, state or federal Marketplaces, or individual market health insurance insurers, effective January 1, 2022.
Here are the protections in a nutshell:
- Any emergency service, no matter where it is given, must be billed the same as “in-network” services—without the requirement of prior authorization.
- Your cost-sharing (like co-insurance or a deductible) for both emergency and non-emergency services has to be based on in-network provider rates.
- Certain high cost out-of-network charges at an in-network facility (for exmple, an anesthesiologist or surgeon), are banned and, in other instances, require advanced notice with prior consent before an out-of-network provider can bill you at a higher out-of-network rate.
The financial consequences of surprise billings can be devastating. This new rule will provide peace-of-mind in what is likely an already upsetting situation. ALICEhelps gives you a place to securely record your insurance information, upload documents, and keep your key healthcare data private. When needed, you can instantly and securely make insurance information accessible to providers, extending your peace of mind.