Unexpected Medical Bills: Understanding the No Surprises Act

Healthcare costs can be overwhelming, especially when you receive an unexpected bill. To protect consumers from these surprise expenses, the No Surprises Act (NSA) was enacted in 2022. However, it’s crucial to understand how it applies to different situations like physical therapy visits.

What is the No Surprises Act?

The NSA aims to prevent surprise medical bills, often incurred when patients unknowingly receive care from out-of-network providers, especially during emergencies. Out-of-network providers are not part of your insurance plan’s network and can charge you more for their services.

Does the NSA Apply to Physical Therapy Visits?

The NSA applies to emergency services and certain non-emergency services provided by out-of-network providers at in-network facilities. However, it does not apply to non-emergency services provided at out-of-network facilities, such as physical therapy clinics.

Understanding Insurance Coverage for Physical Therapy

When you visit a physical therapist, it’s crucial to verify their in-network status with your insurance plan. If they are out-of-network, you may be responsible for a higher percentage of the costs.

Here are some tips to avoid surprise physical therapy bills:

– Ask about in-network status: Confirm with the physical therapy clinic if they are in-network with your insurance plan.

– Check your insurance portal: Most insurance companies provide online portals where you can verify coverage for specific providers and services.

– Request a Good Faith Estimate: Federal law requires healthcare providers to provide a Good Faith Estimate of charges for non-emergency services, including physical therapy. Ask your physical therapist for this estimate before receiving treatment.

– Review your Explanation of Benefits (EOB): After each visit, review your EOB from your insurance company to ensure you’re only being billed for services covered by your plan.

What to Do if You Receive a Surprise Bill

If you receive a surprise bill after physical therapy visits, here are some steps you can take:

– Contact your insurance company: Explain the situation to your insurance provider and request their assistance in resolving the issue.

– Contact the physical therapy clinic: Discuss the unexpected charges with the clinic and ask for an explanation.

– Negotiate a payment plan: If you cannot afford to pay the bill in full, explore the possibility of negotiating a payment plan with the physical therapy clinic.

– File a complaint with your state insurance department: If you believe the physical therapy clinic has violated the NSA or other insurance regulations, you can file a complaint with your state insurance department.