How many times have you gotten a medical-related bill in the mail and been shocked at the fees when you opened it up?
There is help available for people fighting surprise medical bills.
The No Surprises Act is meant to help stop surprise medical bills, but also help people find answers when they run into a bill issue.
The federal law went into effect in 2022. It gives consumers protections from surprise medical bills under certain circumstances and there’s also a help desk set up to help people who have questions.
What is a surprise medical bill?
The U.S. Centers for Medicare & Medicaid Services explains surprise billing like this: Surprise billing is a type of balance billing, which occurs when a provider bills a consumer for the portion of a bill that the consumer’s health insurance plan or coverage doesn’t cover. A surprise bill is an unexpected balance bill for certain types of out-of-network costs that aren’t covered. Surprise billing can often happen when a person does not have the chance to select an in-network provider, such as during a medical emergency.
The No Surprises Act protects people who are covered under group health plans, group and individual health insurance coverage, and the Federal Employees Health Benefits (FEHB) program carriers from surprise medical bills when they receive most emergency services. Also impacted:
- Non-emergency items and services from out-of-network providers with respect to patient visits to certain in-network facilities
- Services from out-of-network air ambulance service providers
Here is new information on how The No Surprises Act works.
How to Get Help and File a Complaint related to surprise medical billing
There is a help desk set up to answer your questions.
Here’s what the help desk can do:
- Review the complaint to determine if the health insurance company, health plan, health care provider, health care facility, or air ambulance provider followed surprise billing rules.
- Investigate complaints about compliance with federal laws under the Centers for Medicare and Medicaid Services’ (CMS) jurisdiction.
- When appropriate, refer the complaint to an applicable federal or state enforcement authority, which could determine if the provider or facility must adjust their charges.
- Try to find patterns of problems that may need further review.
- Help consumers understand what documentation they should submit or what next steps they should take.
- Help answer questions or direct the consumer to someone who can.
- Connect consumers with a local Consumer Assistance Program (CAP), where available, for additional help.
Call the Help Desk at 1-800-985-3059 to get help submitting your complaint or to find out your next steps. They can help you in English, Spanish and over 350 other languages.
Sometimes the ‘No Surprise Act’ help desk will refer you to certain organizations in Texas
Here is what CMS.gov says about Texas customers who need help.
Texas Health Options assists consumers with health insurance questions or problems. You can contact them at 1-800-252-3439.
The agencies listed here can help you take advantage of some of these protections and benefits, and they can answer your questions about different types of coverage.
If you need health insurance, be sure to check out HealthCare.gov’s Plan Finder. It will help you find and compare healthcare coverage options in your area.
Texas Senate Bill 2476 to help stop certain surprise billing
A new Texas law took effect on January 1st related to surprise ambulance billing. It requires your insurance carrier to cover all ambulance charges outside of your co-pay and deductible even when the ambulance company is out of network.
This would eliminate those surprise bills.