Smart Benefits: An End to Surprise Medical Bills

Smart Benefits: An End to Surprise Medical Bills

With 4 in 10 insured adults reporting they’ve received a surprise medical bill, provisions in the recently passed economic relief package designed to protect patients from being billed for amounts their insurance company didn’t cover when using an out-of-network provider are a welcome relief to employees and employers alike.

The law goes into effect in 2022 and, once it does, patients won’t be billed any more when using a non-network provider than what they would normally pay for in-network services at an ER or hospital. In these situations, people are sometimes treated by a physician who doesn’t accept their insurance – even if the hospital does. For example, this can happen when a patient undergoes surgery but the anesthesiologist isn’t part of the same network as the hospital.

When implemented, the law will leave it up to the insurance company and healthcare provider to negotiate a fair price – and the patient is off the hook for the balance.

GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLAST

The measures in the law will ultimately lower healthcare costs for employees and employers. Until they’re implemented, there are steps employees can take to prevent surprise medical bills in both hospital and office care settings and manage their healthcare costs. Encourage employees to:

 

1. Conduct Network Research: Checking network coverage when making medical appointments can reduce the use of out-of-network providers.

 

2. Communicate with Providers: Employees should tell their doctors they only want to use in-network services like labs.

 

3. Confirm Correct Billing Codes: Becoming familiar with billing codes for tests and services covered by the health plan will enable employees to speak up if, for instance, a preventative care visit is being billed as a visit for a specific symptom.

 

4. Understand State Law: Some states already have laws in place to protect patients from balance billing which can range from providing for dispute resolution processes to holding the insurer responsible for the balance-billed amount.

 

5. Negotiate: If an employee is billed for out-of-network care, they can try to negotiate a lower fee with the doctor or hospital or even the health insurer. At a minimum, they may be able to arrange for a payment plan.

Sam Slade is Managing Director, Employee Benefits, at The Hilb Group of New England, where he delivers consulting and brokerage services to local employers. He has extensive experience in all aspects of employee benefits, including underwriting, plan design, communications, compliance, and analytics, with a particular focus on alternative funding and self-insurance. Sam lives in South Kingstown with his wife and three sons.