You Tube Medical Debt Episode 5 Using the No Surprise Act to Manage your Medical Debt

EPISODE 5

 

Today’s program:  MEDICAL DEBT: THIS IS THE FIFTH EDITION FOCUSING ON SOLUTIONS.  HOW TO USE THE NO SURPRISE ACT AND HOW TO NEGOIATE MEDICAL DEBT.

I’m Gary and I’m Jay and we will be hosting today’s program.

  • We are not Clinical people.
  • We are experienced in the Business of Healthcare with over 50 years of combined experience.
  • We bring an Insiders view of how healthcare works.
  • Our goal is to share our knowledge with consumers.

GP:  Career in spans managing hospital and physician revenue cycle operations that include

Pt Admission, Precertification, Ins verification, billing and medical collections

 

JH:  Chief Financial Officer for several large healthcare systems

 

Here we go with today’s program:  IDENTIFYING MEDICAL DEBT SOLUTIONS

 

First, let’s recap:  What is Medical Debt?

Medical debt is debt incurred by individuals due to health care costs and related expensesMedical debt is different from other forms of debt, because it is usually unplanned, accidental, or faultlessMedical debt can have negative impacts on households, such as reducing their spending on other essential items, or preventing them from seeking needed medical care or treatmentMedical debt can also lead to bankruptcy.

Do you have a Medical Bill?

 

If yes, medical debt can indeed be a significant financial burden for individuals and families. When someone incurs medical expenses that are not fully covered by insurance or you do not have insurance, you may end up owing money to healthcare providers. This debt can accumulate due to various factors, such as high deductibles, copayments, out-of-network charges, or uncovered services.

LET’S START WITH THE NO SURPRISE ACT

 

The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.

Starting in 2022, there are new protections that prevent surprise medical bills. If you have private health insurance, these new protections ban the most common types of surprise bills. If you’re uninsured or you decide not to use your health insurance for a service, under these protections, you can often get a good faith estimate of the cost of your care up front, before your visit. If you disagree with your bill, you may be able to dispute the charges. Here’s what you need to know about your new rights.

What are surprise medical bills?

Before the No Surprises Act, if you had health insurance and received care from an out-of-network provider or an out-of-network facility, even unknowingly, your health plan may not have covered the entire out-of-network cost. This could have left you with higher costs than if you got care from an in-network provider or facility. In addition to any out-of-network cost sharing you might have owed, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid, unless banned by state law. This is called “balance billing.” An unexpected balance bill from an out-of-network provider is also called a surprise medical bill.

People with Medicare and Medicaid already enjoy these protections and are not at risk for surprise billing.

What are the new protections if you have health insurance?

If you get health coverage through your employer, a Health Insurance Marketplace®,[1] or an individual health insurance plan you purchase directly from an insurance company, these new rules will:

  • Ban surprise bills for most emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
  • Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
  • Ban out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of a patient’s visit to an in-network facility.
  • Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections (i.e., you must receive notice of and consent to being balance billed by an out-of-network provider).

What if you don’t have health insurance or choose to pay for care on my own without using my health insurance (also known as “self-paying”)?

If you don’t have insurance or you self-pay for care, in most cases, these new rules make sure you can get a good faith estimate of how much your care will cost before you receive it.

What if I’m charged more than my good faith estimate?

For services provided in 2022, you can dispute a medical bill if your final charges are at least $400 higher than your good faith estimate and you file your dispute claim within 120 days of the date on your bill.

What if you do not have insurance from an employer, a Marketplace, or an individual plan? Do these new protections apply to me?

Some health insurance coverage programs already have protections against surprise medical bills. If you have coverage through Medicare, Medicaid, or TRICARE, or receive care through the Indian Health Services or Veterans Health Administration, you don’t need to worry because you’re already protected against surprise medical bills from providers and facilities that participate in these programs.

What if my state has a surprise billing law?

The No Surprises Act supplements state surprise billing laws; it does not supplant them. The No Surprises Act instead creates a “floor” for consumer protections against surprise bills from out-of-network providers and related higher cost-sharing responsibility for patients. So as a general matter, as long as a state’s surprise billing law provides at least the same level of consumer protections against surprise bills and higher cost-sharing as does the No Surprises Act and its implementing regulations, the state law generally will apply. For example, if your state operates its own patient-provider dispute resolution process that determines appropriate payment rates for self-pay consumers and Health and Human Services (HHS) has determined that the state’s process meets or exceeds the minimum requirements under the federal patient-provider dispute resolution process, then HHS will defer to the state process and would not accept such disputes into the federal process.

As another example, if your state has an All-payer Model Agreement or another state law that determines payment amounts to out-of-network providers and facilities for a service, the All-payer Model Agreement or other state law will generally determine your cost-sharing amount and the out-of-network payment rate.

 

LETS DISCUSS:  How to Negotiate a Medical Bill

Negotiating a medical bill can take time and research. Your options could also depend on your insurance company, financial situation, where you live and the company that provided the medical treatment.

Ultimately, your success will depend on your unique circumstances as well as your tenacity and negotiation skills. Here are several strategies you can try:

  • Ask for an itemized bill. One of the first things to do is request an itemized bill from the health care provider. It should cover everything you’re being charged for with line-by-line amounts and the associated codes. Review the bill for errors, such as services or medication you didn’t receive or duplicate charges.
  • Look over the explanation of benefits (EOB). Your insurance company may send you an EOB. It’s not a bill, but you can compare it to your itemized bill to look for discrepancies. If part of your bill should have been covered by insurance but wasn’t, contact your insurance company to sort it out.
  • Look into financial assistance policies. Hospitals, clinics and medical service providers may offer financial assistance to low-income patients. Some states even require both for-profit and nonprofit hospitals to have financial assistance programs. But you may need to ask about their availability. The National Consumer Law Center has a guide for helping lower-income patients deal with medical bills.
  • Call the provider to ask about options. When there aren’t any errors, you can still reach out to the provider to discuss your bill. You can ask if there are any waivers, hardship or relief programs available, or a discount for making a prompt down payment or full payment. Some providers may also have payment plans with low or no interest.

If you don’t feel comfortable negotiating on your own, there are professional companies and individuals that will review your bills and negotiate on your behalf. But there may be a one-time fee, a fee based on your savings or a combination of the two. Ask your employer or union representative if they offer medical bill negotiation benefits, as these are sometimes available.

While the negotiation process can be complicated, rest assured that a short delay won’t hurt your credit, even if the bill is sent to collections.

The major consumer credit bureaus—Experian, Equifax and TransUnion—don’t include unpaid medical bills on your credit reports until at least 180 days have passed since the bill’s due date. Although paid collections accounts can show up in credit reports, the bureaus will remove medical collection accounts that are paid by an insurance company.

If you’re uninsured, then you may be charged a higher rate. Look up the fair market price for the care you received. This is the amount that providers regularly accept from insurance companies as payment in full, and it’s the amount you should aim for in your negotiations. You can find this information in the ​Healthcare Bluebook.3

Can You Settle Medical Bills for Less?

If you’re unable to negotiate a lower bill, the provider or collection agency might accept a settlement, which is an arrangement that has you pay less than the full amount owed.

The option to settle what’s owed may have already come up with the provider’s billing department if you called to discuss a discount for making a payment in full, or a down payment toward a larger payment. However, their initial offer may have been too high, or the billing department may have pushed you toward a payment plan instead.

One option is to look up health care costs on Healthcare Bluebook and FAIR Health. These cost comparison sites can show you approximately how much the same procedures cost elsewhere, and can act as a reliable data point you can use during your negotiations.

Also, keep in mind that health care providers may charge different rates depending on whether you’re insured, in-network or out-of-network. If you’re not insured, see if you qualify for Medicaid or, at least, ask to pay the same amount as insurance companies.

If you want to make a settlement offer, you might need to mail or fax a letter. Ask the provider about the proper submission process, and then follow up a few days later to make sure the offer was received.

Look for Assistance Elsewhere

When you don’t find an error and the provider won’t negotiate, you could look into other options for getting help with medical bills. If you need to borrow money, medical credit cards and loans may be available. But these shouldn’t necessarily be the first option you pursue—particularly if repaying the debt will make it difficult to afford essentials. Having a good credit score can help you secure financing at more reasonable rates.

If you haven’t already tried, you may want to reach out to a medical billing advocate or negotiator to get a professional option. Some may agree to look over your bills for free to determine if they might be able to help.

You could also look into getting help from charitable organizations that help with medical bills. Some of these focus on particular types of patients, such as children or people who are dealing with certain illnesses. Pharmaceutical companies may also offer discounts or free prescriptions and medical supplies through a pharmaceutical assistance program. While these won’t necessarily wipe previous bills, they may make your health care more affordable.

 

IMPORTANT TAKE AWAYS

HCNC is your healthcare partner that offers healthcare consumers information to navigate the healthcare maze via our website.

The program and take away information of the program will be available on our website www.healthcareconsumernavigatorcenter.com.

REMEMBER:  THIS IS OUR  5TH YOUTUBE PROGRAM IN THIS SERIES, SEVERAL MORE TO FOLLOW

Our next program topic will be:   1. Healthcare Discounts,  2. Do you qualify for Social Security Income/Social Security Disability Income and 3.  How to document your conversation with a healthcare provider.

 

This concludes our program MEDICAL DEBT SOLUTIONS, and we hope the program explained telehealth care and has answered some of your questions.

 

 

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