Surprise Balance Billing After Car Accidents
I spend a good amount of time on every case tracking down all potential medical bills. My goal at the end of every case is to give the client a check free and clear of any further liabilities. I consider this service an important part of my role as your lawyer. Despite great effort, obtaining this goal on every case can be difficult.
Tracking down all a client's medical bills after an accident is not always straightforward. Most people know that there is a hospital emergency room bill. Many do not know that there is also a treating physicians bill from the doctor who treated in the emergency room. Sometimes imaging done at a hospital is not included in the hospital bill, but will be charged through a different company. Further compounding problems, sometimes this imaging bill does not cover the bill for the doctor who read the imaging. This creates yet another bill that needs to be tracked down and accounted for.
These surprise bills can cause problems. One can call billing companies, be assured that the bill you have is all there is, and then months later find out that they were wrong. Some of these bills are not sent to the patient for many months after treatment. It is frustrating when they are sent after the client’s personal injury case has already been closed.
What is worse, once these bills arrive, they can have large balances attached to them that the client’s health insurance will not cover. This is called surprise balance billing. You would think hospitals would be upfront about where to find this information. Some try to be, but most hospital billing companies are unaware of what doctors group handles the treating physicians bill for emergency room treatment.
Surprise balance billing occurs when a patient receives a bill for the balance of the cost of treatment after unknowingly receiving care from an out-of-network provider or facility. Nothing like an unexpected medical bill to create even more anxiety. It happens often with car accidents because people do not choose where they will get treatment, so it is often out of network with their health insurance.
A 2020 study found that, "for people in large employer plans, 18% of all emergency visits and 16% of in-network hospital stays had at least one out-of-network charge associated with the care in 2017." That same study cited doctors’ bills associated with emergency room treatment to make up a large portion of those bills.
A new federal law, the No Surprises Act, protects you from:
- emergency out-of-network medical bills, including those from air ambulance providers, and
- out-of-network bills for non-emergency services at an in-network facility.
This law went into effect at the start of 2022. It applies to self-insured health plans offered by employers as well as health insurance companies. A facility (such as a hospital) or a provider (such as a doctor) may not bill you more than your in-network cost sharing amount for emergency services. This is true even if the emergency services you received were at an out-of-network facility or performed by an out-of-network provider.
Under your health plan, you are still responsible for cost sharing amounts that may include copays, coinsurance, and deductibles.
You are also protected when you receive non-emergency services from out-of-network providers at in-network facilities. An out-of-network provider may not bill you more than your in-network co-pay, co-insurance, or deductible for services performed at an in-network facility. You can still consent in advance to receive care from an out-of-network provider in some situations and agree to pay the provider the out-of-network cost sharing amounts.
Despite recent federal laws, transparency of medical bills is problematic. Patients often do not know whether certain procedures will be covered by their health insurance. When in an inpatient setting, such as at an emergency room visit, patients may not have any meaningful choice. This is especially true after a car accident.