New ban on surprise medical bills begins today

Several studies have found that about 20 percent of U.S. patients who received emergency care were treated by someone outside of their insurance network, including emergency physicians, radiologists, or labs. Any of these providers could send patients an additional bill after the fact, and some medical groups did so routinely. Such bills are now illegal.

There is one important exception.

The new law does not prevent ambulance companies from billing you directly for their services if they are on the roads. It provides protection against surprise air ambulance bills.

Ground ambulances have been excluded from recent legislation because lawmakers determined they would need a different regulatory approach. Congress has created a commission to study the issue and may consider reforms.

Eleven states are blocking ambulances from sending off-grid medical bills. Patients who live in other states are very likely to receive a bill in the mail if they need an ambulance. Research shows that up to half of people who need an ambulance receive such a bill, although the amount is not always large.

For scheduled services, such as knee surgeries, cesarean sections or colonoscopies, it is important that you choose a facility and primary physician that is part of your insurance plan network. If you do this, it is against the law for anyone else who deals with you to send you a surprise invoice. It also solves an important problem. Surprise bills from anesthesiologists, radiologists, pathologists, assistant surgeons and laboratories were common before.

If for some reason you receive such a service and you really want an off-grid doctor to be part of your care, that doctor should usually inform you at least three days before your procedure and offer you a “voucher.” authentic estimate ”of the amount you will be billed. If you sign an acceptance to pay supplement form, you may receive additional invoices. But the hospital or clinic cannot force you to sign such a form as a condition of your care, and the form should include other choices of doctors who will accept your insurance.

“People should really, really think carefully before signing this form because they will be giving up all of their protections,” Kelmar said. She recommended that patients go directly to the part of the form that lists the covered alternatives.

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