As of Jan. 1, a new law is
supposed to prevent most surprise medical bills, but there are some loopholes
to be aware of.
“My health was deteriorating and I had to have a C-section
immediately,” says Kelly Kantor.
When Kantor gave birth to
her son, Hudson, he had to spend two weeks in the neonatal intensive care unit,
but then the medical bills came. Even though her hospital was in network, the
NICU doctors were not – she was told she owed nearly $20,000.
“You wouldn't think – Oh wait! Don't
touch my son! Are you in network?” says Kantor.
Lisa Waterman was hit with
surprise medical bills twice. First, when her son, Dylan, was born, then when
her other, son, Brandon, was bitten by a dog, and the in-network ER called in
an out-of-network plastic surgeon.
“We spent about a year going
back and forth with the plastic surgeon's office, but we still paid almost
$4,000,” says Waterman
Studies have shown six in 10
Americans have been hit with at least one surprise medical bill, but those
nasty surprises should be less common now that Congress has passed the No
Surprises Act.
“You could go and have a
surgery, and the surgeon was covered under your plan, but the anesthesiologist
was not, and so those are the main situations that we were trying to avoid,”
says Rep. Frank Pallone.
The act says you can't get a
surprise bill for most emergency services, even if they're out of network. You
can't be billed more for out of network emergency care than in network, and if
you pay cash, you have to be given a good faith estimate. But Kane In Your
Corner found there are loopholes in the law.
Greg and Sugar Bull, of
California, had twins through a surrogate, then were hit with surprise bills
topping $80,000. Both
babies spent a week in the neonatal ICU, but the insurance company claimed it
was not emergency care. They eventually resolved the case, but health care advocates say what happened
to them can still happen to you.
Ann Marie McIlwain says
there are other red flags to watch for, such as ambulance service. Air
ambulances are covered by the act, but ground ambulances sometimes are not.
“When you are transferred,
let's say from the hospital to a skilled nursing facility, or taken from home
to a hospital, that is not covered in this bill,” says McIlwain. “Unless it's
life threatening, do not get in an ambulance, if you can help it.”
There's one other thing to
watch out for: the calendar. If you get a medical bill that violates the act,
you have 120 days to appeal.