Surprise Medical Bills: Understanding Your Rights Under the ACA

Introduction

Surprise medical bills can be a frustrating and confusing experience for anyone. Receiving a bill out of the blue for medical services you received years ago can be especially unsettling. In this blog, we’ll explore the topic of surprise medical bills and provide you with information about your rights under the Affordable Care Act (ACA).

What is a Surprise Medical Bill?

A surprise medical bill is an unexpected medical expense you receive for services you received from an out-of-network provider. This can happen when you visit an in-network hospital, but receive care from an out-of-network provider, such as an anesthesiologist or radiologist.

What the ACA Says About Surprise Medical Bills

The ACA includes provisions designed to protect consumers from surprise medical bills. The “No Surprises Act” protects you from being billed for out-of-network services at in-network facilities. This means that you cannot be charged more than the in-network rate for these services.

What to Do if You Receive a Surprise Medical Bill

If you receive a surprise medical bill, here are some steps you can take:

Contact your health insurance company. They can help you verify whether the provider is in-network and whether you are responsible for paying the bill.
Negotiate with the provider. You may be able to negotiate a lower payment amount or payment plan.
File a complaint with the state insurance commissioner. If you believe you have been wrongfully billed, you can file a complaint with the state insurance commissioner.

Case Study

The case mentioned in the post is an example of a surprise medical bill. The individual received a bill for lab work that was allegedly performed two years ago. After contacting their health insurance company, they discovered that the lab had made a mistake and the bill was not valid.

Conclusion

Surprise medical bills can be a stressful experience, but understanding your rights under the ACA can help protect you from these unexpected expenses. If you receive a surprise medical bill, do not hesitate to contact your health insurance company and explore your options. By working with your insurance company, you can ensure that you are only paying for the medical services you are responsible for.