HARRISBURG, Pa. (WHTM) — There are new federal protections against surprise medical bills.
Two years ago, a similar bill was proposed in Pa., but it didn’t go anywhere.
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Now consumer advocates are celebrating the federal “No Surprises Act” that took effect January 1.
In an emergency, most patients aren’t thinking about how much their surgery will cost, but in an emergency, most patients aren’t thinking about how much their surgery will cost, but afterward, the bill can come as a complete shock.
“We did a study last year that showed one in three Pennsylvanians, at some point in the past year encountered a surprise medical bill. And that could be anything from, you know, an extra $10 to you know, a bill for $20,000,” said Antoinette Kraus, executive director of the Pennsylvania Access Network.
That’s what happened to Melissa Lafferty’s family member who had to have emergency heart surgery fifth five bypasses.
“Fortunately the health insurance that they had covered everything except for the anesthesiologist and that bill came in at $25,000,” Lafferty said.
The federal No Surprises Act now bans surprise billing in private insurance for most emergency care and many instances of non-emergency care.
It also requires that uninsured and self-pay patients know how much their care may cost and have details about their rights.
“I think it’s great. I actually just went on MyWellSpan for something that my husband had done and I do see now that they have an estimator on their website where people can go and kind of be proactive about that,” Lafferty said.
The law applies to out-of-network facilities and providers and also air ambulances but not ground ambulances.
“They actually are still studying the financial implications of what this would do to EMS because they already know at the federal level that Medicare, Medicaid do not pay anywhere near the cost of an EMS trip as a reimbursement,” said Nathan Harig, assistant chief of Cumberland Goodwill EMS.
Harig says the law is a good thing for consumers, but worries for some emergency providers.
“There’s a double effect. If we charge high rates, no one’s going to use our services and at the same time, we’re trying to make sure that we’re there to respond to them. So we’re trying to do that balancing act,” Harig said.
If you do get a surprise medical bill for services provided after January 1 of this year, that’s illegal and you should submit a request with the Pennsylvania Insurance Department to have that bill reviewed.