By: TAHP | Monday, January 3, 2022

by Blake Hutson, Jamie Dudensing

Looking for some good news to start the year? We’ve got you covered. After a years-long debate, the end of unfair and outrageous surprise medical bills is finally here.

Surprise medical bills happen when patients don’t have the opportunity to select their provider, such as in a medical emergency, and are billed for out-of-network services even though they had no choice in the matter. Without an incentive to bill a fair price, some providers take this opportunity to bill patients outrageous amounts that are stressful to handle, drain the bank, and far too often result in medical debt.

Texans may remember the state legislature tackling the issue in past legislative sessions, but under a new federal law called the No Surprises Act, every American with health insurance is now protected from these bills. Although the details get complicated, it’s actually pretty simple on the patient side. Let’s go over some scenarios:

• If you need emergency care and it turns out the ER doc wasn’t in your insurance network, that doctor is prohibited from sending you bills outside of the deductible and other cost sharing limits you expected to incur.
• Same goes for planned procedures like a knee surgery where your surgeon is in network but you never knew to ask about an assistant surgeon who walked into the room and wants to bill you too.
• What about those anesthesiologists bills where, try as you might, you can never figure out who is actually going to provide the service on the day of the surgery? Banned as well!

Basically, if you don’t get to decide on who treats you and you don’t waive away these protections, you shouldn’t get these extra bills. But, if you can imagine a world in which these bills existed in the first place, you can probably imagine that some physicians are going to try to get around the new law. That’s where this waiver idea comes in — and you should be very wary of signing a form that looks anything like this model notice.

Sneaky health care providers may try to present this form to you ahead of a surgery to get you to sign away your rights to these new protections. Don’t sign it. Call your insurance plan and call their bluff. It’s not fair to ask patients under duress to give up these new rights that we’ve all been demanding for so many years.

As stated on the model form, “You aren’t required to sign this form and shouldn’t sign it if you didn’t have a choice of health care provider when you received care.” In the case of a planned surgery, you’ve probably worked out the insurance and payment details weeks in advance with your primary surgeon’s office. But it’s those pesky ancillary providers that may try to slide this form in front of you at the last minute and you and your surgeon should both be appalled.

It’s unclear how enforcement of the new law is going to work and if Texas will step up to make sure that health care providers are following the law. If you do still get a surprise bill that you think runs afoul of the new law, first off, don’t pay it. Call your health care provider’s office and remind them of the new law. Then call your health plan and let them know what’s going on. 

You can also file a complaint with the provider’s licensing board. For Texas physicians, that’s the Texas Medical Board, and you can file that complaint using an online form. For hospitals and other medical facilities, you can complain to the Texas Health and Human Services Commission. 

Unfortunately, there’s one glaring omission in the new law—ambulance rides. Of course you can’t choose which ambulance company picks you up and research shows that the overwhelming percentage of ambulance providers are out-of-network, leaving patients dangerously exposed to surprise bills. But crafters of the new law decided to study the topic more before banning ambulance surprise bills. One caveat though, air ambulance rides were included in the new law and those potentially thousands of dollar bills are also a thing of the past. 

Health care prices are skyrocketing and provider consolidation and private equity firms have been throwing fuel on the fire. Ending surprise bills doesn’t fix all our health care system woes but under the new law, providers have been forced to release the hostage and patients can breathe a sigh of relief that their next emergency won’t be followed by a family debt crisis.