All You Ought to Know About Surprise Medical Bills

When you obtain insurance cover, it is commonly accompanied by a catalog showing your insurance network. This network is categorized into providers and facilities or services, essentially guiding you to know what treatment type can be covered and what hospitals that specific treatment type is available within the ambits of your insurance. However, it is not unusual for patients to unknowingly visit medical centers outside the insurance network and proceed to receive treatment. Since the patient’s insurance does not directly cover these services, health providers proceed to issue “surprise medical bills.”

A surprise medical bill is an amount of money charged on a patient by health providers or facilities outside the patient’s insurance network. To be precise, the surprise out-of-network medical bill is equal to the difference between what the patient’s insurance cover would have settled and the actual total bill by the provider or facility (Surprise Medical Bills, n.d.). This billing system has unfavorable implications on the consumers of these services. Hence, the laws of Colorado had to make a couple of amendments to ensure the protection of the consumers.

The enactment of the first law came in 2019 and became effective on the 1st of January, 2020. The purpose of the new law was to protect Colorado consumers who have insurance covers that the government regulates from balance billing or surprise billing. This initial law only favored state-regulated insurance, leaving non-state-regulated insurance policyholders vulnerable to the adverse billing practices. Protection was accorded to those whose insurance cards showed proof of the cover being state-regulated. Protection was offered whereby patients sought emergency treatment in either facility or from providers out of the network or whereby a patient in an in-network facility received a non-emergency service but from an out-of-network provider.

The No Surprises Act

As of this year’s commencement, 2022, this protection has been extended to non-state-regulated insurance covers. It is essential to understand that you are still required to pay for the treatment received from out-of-network providers and facilities. The remedy that the law introduced is that you will only be charged nothing beyond the amount set by your cover. If you receive treatment worth $50 as per your insurance cover but $75 as per the out-of-network rate, you are only liable to pay $50 and none of the $25 on top.

This is How My Insurance Can Come Through

Your insurance company is your friend. Before making any appointments, reach out to them and consult on the services available and the casts as per the cover. Furthermore, obtain clear information on the in-network to avoid unnecessary ancillary costs. Beyond this, your insurance will prove instrumental to you when you have any suspicions or questions about the bill you receive after treatment. Make sure you contact them immediately and find out whether a claim has been sent to them. Also, find out the proportion you are supposed to pay to avoid overpayment.

Your insurer should have mechanisms that facilitate the filing of complaints or internal appeals where you consider their decision to deny your claim faulty. If this amount is surprise billing, then the insurance is in a position to handle the matter more effectively for you.

Further avenues of appeal are offered by the Colorado Department of Insurance, which could take up the matter and settle it for you. At this point, you may also want to report your case to the Attorney General in Colorado to aid in statistics and analysis of the issues in the region.

You Are Safe and Sound with Combs and Brown

Our consultancy services are the best around. We have a wealth of knowledge and experience with insurance matters, ready to help you out. Please Find us on 100 Park Avenue, Suite 202, Steamboat Springs, Colorado (Combs and Brown, n.d.). You can also call our attorney on 970-871-7400 to book your appointment today!

Works Cited

Combs and Brown. (n.d.). Retrieved from Steamboat Springs Criminal Defense Attorneys BOLDLY FIGHTING FOR JUSTICE: steamboatdefense.com

Surprise Medical Bills. (n.d.). Retrieved from Colorado Consumer Health Initiative: https://cohealthinitiative.org/need-help/surprise-medical-bills/