Several studies found that about 20 percent of U.S. patients who received emergency care were treated by someone outside their insurance network, including emergency room physicians, radiologists, or labs. Each of those providers could send patients an additional bill afterwards, and some medical groups did this routinely. Such accounts are now illegal.
There is one important exception.
What does the law mean if I need an ambulance?
The new law won’t prevent ambulance companies from billing you directly for their services when they drive on the road. It does offer protection against surprise bills from air ambulances.
Ground ambulances were left out of recent legislation as lawmakers determined they needed a different regulatory approach. Congress has set up a committee to study the issue and consider possible reforms.
Eleven states prevent ambulances from sending out-of-network medical bills. Patients living in the other states are likely to receive a bill in the mail if they need an ambulance. Research shows that no less than half of the people who need an ambulance receive such a bill, although the amount is not always the same.
What does the law mean for routine hospital procedures?
For scheduled services, such as knee surgery, cesarean sections, or colonoscopies, it is important that you choose a facility and chief physician that are in your insurance plan’s network. If you do, the law prohibits anyone else treating you from sending you a surprise bill. This also addresses a major problem. Surprise bills from anesthesiologists, radiologists, pathologists, assistant surgeons, and labs used to be common.
If for some reason you receive such a service and you really want an out-of-network physician to be part of your care, then that physician will typically need to notify you at least three days before your procedure and provide a “good faith estimate.” of how much you will be charged. If you sign a form that you agree to pay extra, you can get extra bills. But the hospital or clinic cannot force you to sign such a form as a condition of your care, and the form must include other choices from doctors who accept your insurance.
“People really need to think very carefully before signing that form because they’re relinquishing all their protection,” Ms Kelmar said. She advised patients to go directly to the section of the form that lists the alternatives being treated.