New law aims at controlling billing of medical care | Quigley - nj.com
Let’s look beyond all those headlines promising “No more surprise medical bills.” They’re accurate as far as they go. But all they really mean is you won’t be surprised. Not necessarily that your medical bills will be fewer or lower.
To reduce your medical bills was the aim, of course. But you must be careful or you might be surprised anyway.
Congress enacted the law more than a year ago and after some fine-tuning it went into effect January first. It is very pro-consumer and many medical groups fought it, but even a savvy consumer should be alert to ways providers can work around the law.
Basically what it says is that when you seek medical care, even in an emergency room, you and/or your insurance company should get only a single bill for covered care.
Prior to this law, as many of you found out the hard way, you might get a bill from the hospital for use of its ER, another from the doctor who treated you, a third from the radiologist who took your x-ray, a bill from a laboratory for your tests, and a fifth from a physician who just stopped by afterward to ask how you were feeling.
If you had major surgery you would get a bill from the chief surgeon, of course, but you might also have received invoices from the doctors who assisted her, the anesthesiologist, the doctors who observed you in the post-op suite, and the hospitalists who oversaw your care for a few days afterward. And most of those folks you never saw, never learned names, never were quite sure what they did for you.
Now you merely have to make certain to choose a doctor and hospital that accept your insurance. That should do it.
But once you are inside, look for posted notices saying you might be cared for by someone not in your insurance network. Hospitals are posting warning signs hoping that takes care of the “surprise” part.
You might be asked to sign a form acknowledging your care could be provided by someone outside your insurance network. When you are in a hospital, groggy and maybe scared, you’ll probably sign anything.
Don’t. Despite discomfort read everything presented to you or ask someone you trust to tell you what it says. You can refuse to sign.
What happens if you don’t sign and there’s no one else who can provide the care you need?
The hospital will always act in your best interest and make sure you get that care. They’ll fight about the bill afterwards. The law includes a dispute process to hash out that kind of problem and any other situations where not everyone agrees.
Pre-planning matters. If you are going in for elective surgery, for instance, your surgeon must notify you three days in advance if he’ll have help from another doctor not in your network. Then he’ll give you a form to sign, along with a list of other surgeons who do accept your insurance. It’s your call.
Of course, you will always be responsible for paying any deductibles or co-pays your insurance contract requires. You might get an additional bill from an ambulance service because few are enrolled in all insurance networks.
It is important to choose your caregiver carefully in any non-emergency situation. There are many websites showing which doctors accept which insurance, rating doctors for their performance. It’s recommended you call around and find the best doctor for your needs and make sure that your physician and her team are in your network so the outcome is no surprise.
A former assemblywoman from Jersey City, Joan Quigley is the president and CEO of North Hudson Community Action Corp.
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source: https://www.nj.com/opinion/2022/01/new-law-aims-at-controlling-billing-of-medical-care-quigley.html
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