Why Did I Get a Surprise Medical Bill from My ACA Health Insurance?

Unexpected medical bills can be frustrating and confusing, especially when you believe you have health insurance coverage. Many individuals who have ACA health insurance have reported receiving large, unexpected medical bills. In this blog, we will discuss common reasons why you may have received a surprise medical bill under the Affordable Care Act (ACA).

ACA health insurance plans are designed to provide essential health benefits, including coverage for preventive care, emergency services, and hospitalizations. However, there are some situations where you may be responsible for paying out-of-pocket costs, even if you have health insurance.

Here are some potential reasons why you may have received a surprise medical bill:

Balance Billing: Balance billing occurs when a healthcare provider bills you for the difference between the amount they charge for a service and the amount your insurance company pays. This can happen if you receive care from an out-of-network provider or if your insurance plan has a high deductible.
Lack of Coverage: Not all medical services are covered by ACA health insurance plans. For example, cosmetic procedures, elective surgeries, and experimental treatments may not be covered. If you receive care for a service that is not covered by your plan, you will be responsible for the full cost.
Deductible and Coinsurance: Most ACA health insurance plans have a deductible, which is the amount you must pay out-of-pocket before your insurance starts to cover costs. You may also have coinsurance, which is a percentage of the cost of a covered service that you are responsible for paying. If you have a high deductible or coinsurance, you may be responsible for a significant portion of your medical bills.
Errors: Sometimes, medical bills contain errors. If you receive a bill that you believe is incorrect, you should contact your insurance company immediately to dispute the charges.

If you receive a surprise medical bill, it is important to contact your insurance company to understand why you are being billed. You may be able to negotiate a payment plan or find out if there are any financial assistance programs available to help you cover the costs.

Unexpected medical bills can be stressful, but it is important to remember that you are not alone. If you have questions about your ACA health insurance coverage or need assistance with a surprise medical bill, please reach out to a licensed insurance agent for guidance.