New Rules Will Help Protects Patients From Surprise Medical Billing

Mileidys Almaguer Iniguez avatar

by Mileidys Almaguer Iniguez |

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In 2012, I had the unpleasant experience of receiving unexpected out-of-network medical bills for a hospitalization in Florida. There was nothing I could do about it. At the time, I wasn’t aware of any laws that might have protected me.

But I now know that Florida is among the U.S. states that have “balance-billing” protection laws. This means that insured patients are, for the most part, responsible only for in-network healthcare costs, which protects them from surprise billing.

In my case, I had to agree to a payment plan to cover the out-of-network service costs. When patients can’t pay, hospitals forward their bills to collection agencies that call patients nonstop. Healthcare consumers are forced to experience this uncomfortable situation because a hospital used an out-of-network provider, and it can become a significant financial burden on a patient.

Patients like me who have a rare disease are vulnerable to shocking medical bills because often there are no available treatments. Many of us must seek immediate medical attention in emergency rooms when our symptoms unexpectedly worsen.

This is what happened to me before I was finally diagnosed. I had to go to the emergency room several times, and I often received out-of-network charges. On one occasion when I was billed for out-of-network costs, the healthcare providers decided not to do an MRI on me because they wanted to reserve that type of testing for urgent cases. Meanwhile, I was having a neuromyelitis optica (NMO) attack. The people working that night didn’t realize it was an NMO attack and sent me home, where my condition worsened. The next day, I decided to go to a different emergency room, where I was immediately admitted to the hospital.

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For my first ER visit, I was billed by doctors who were out-of-network. I didn’t think twice about paying those bills because it was an emergency. But I now know there is legislation to protect healthcare consumers in situations like this.

Thankfully, the administration of President Joe Biden has issued an interim final rule on surprise medical billing, a measure that was supported by more than two dozens patient organizations. The new rule, which takes effect on Jan. 1, 2022, will restrict abusive out-of-pocket costs due to surprise billing for Americans who have commercial or employer-based healthcare plans. The rule will help make the healthcare system more affordable and accessible.

It also prohibits surprise medical billing for emergency services. If this rule had been in place when I had my stressful trip to the emergency room, I wouldn’t have had to pay out-of-network costs for services that didn’t help me.

Here in Massachusetts, Gov. Charlie Baker signed legislation earlier this year titled “An Act Promoting a Resilient Health Care System That Puts Patients First.” This law provides additional protection to patients by requiring advance notice about whether a provider is in a patient’s insurance network or not. That helps patients avoid surprise medical billing.

It is a relief to know that I am now protected in case of unexpected health crises, such as being out of town while becoming unexpectedly sick. In that situation, I can now visit the nearest hospital to seek immediate care.

I hope these new rules will help put a stop to abusive billing by emergency room professionals. Providers like anesthesiologists, radiologists, and ER specialists, for example, often don’t want to be part of insurance networks. But the services these professionals provide are a matter of life or death for patients like me. I understand that they deserve decent compensation. But patients don’t choose to get sick.

There must be common ground between patients and providers. I believe that common ground is achieved by fair legislation that protects both sides.

I can’t sufficiently express my gratitude for the U.S. healthcare system. But it is important that we fix what doesn’t work. In terms of surprise billing, I think we’re moving in the right direction.


Note: Neuromyelitis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Neuromyelitis News or its parent company, BioNews, and are intended to spark discussion about issues pertaining to neuromyelitis optica spectrum disorder.


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