Month: June 2024

As a physician, can you recall any instances when a patient left your office in dismay after a successful operation only to return a few weeks later when they received an enormous bill? Have you ever left the hospital relieved? Then, the insurance company’s refusal to cover the services shocked you with a big bill. If so, you have fallen prey to the evil known as “SURPRISE MEDICAL BILLS,” or balance bills. Balance billing happens when a patient gets emergency care at an in-network institution from an out-of-network physician.

In 2022, lawmakers enacted the No Surprises Act to address this issue. It shields individuals receiving emergency treatment or care from an out-of-network physician at an in-network hospital from unexpectedly high medical expenses. The Act restricts the amount consumers must pay out-of-pocket for emergency care or visits to an out-of-network physician at their regular in-network hospital. They determine this cap using the average cost of the service in that region.

Let’s consider a scenario where a man visits his local hospital with a broken arm, but his insurance does not cover the orthopedic surgeon who treats him. Without legislation, that orthopedic doctor could have billed the patient a considerable amount. However, due to the No Surprises Act, the orthopedic surgeon is only permitted to bill the patient the going rate for fixing a broken arm in that town.