A federal law banning surprise medical bills went into effect Jan. 1, and Orthopedic & Sports Institute of the Fox Valley is prepared to continue providing patients with the same level of care and transparency they’ve come to expect.
The No Surprises Act protects people covered under group and individual health plans from unanticipated medical expenses after receiving care from out-of-network physicians, health professionals, hospitals, or providers – most often in an emergency care setting. The bill essentially requires health insurers and healthcare providers to work together to ensure consumers are informed about charges and protected from non-coverage.
The law requires that private health insurance companies cover certain out-of-network bills and apply consumer copayments or other costs as if the care had been delivered by in-network providers. It also prohibits doctors and hospitals from charging consumers more than they would have to pay for the applicable services if the providers were in-network with the insurance company.
Surprise medical billing is commonly referred to as “balance billing.” Under this system, patients could inadvertently receive care from an out-of-network provider or facility then find out later that the cost of services would not be fully covered by their medical insurer – which would result in the patient receiving “surprise” bills. This led to the No Surprises Act.
The act also benefits those who do not have insurance or choose to self pay by ensuring patients can get a good-faith estimate on how much the care will cost before it is received. If the charges are more than $400 more than the estimate, patients are legally able to file a dispute claim within 120 days of the billing date.
To ensure it is in compliance with the act, OSI has an on-site financial advocate for patients. If you have a question regarding your bill, please call 920-560-1000.