InvestigatorsMatter for Mallory


Were you overcharged? Understanding new protections against surprise medical bills

medical debt.png
Posted at 6:43 PM, Apr 19, 2022
and last updated 2022-04-19 19:18:27-04

BALTIMORE — New federal protections are helping patients avoid surprise medical bills. The No Surprises Act took effect January 1, 2022.

It doesn’t apply to a Sykesville couple’s medical emergency last year, but it can help other families deal with sky-high air ambulance bills.

Teri Gibson and Bruce Williams have traveled to Jamaica for the last 20 years with no incidents, but in May, Williams suffered a medical emergency requiring an air ambulance to a hospital in Florida.

“That bill was $17,754,” said Gibson.

READ MORE: Maryland couple disputes $175,000 air ambulance bill after emergency on overseas vacation

Gibson hadn’t yet received authorization from her insurance company, so she had to pay the balance upfront. Nearly 10 months later, she was finally reimbursed with the help of the Maryland Office of the Attorney General Health Education Advocacy Unit (HEAU).

“There are now new protections for consumers like the Gibsons,” said Kimberly Cammarata, director of the HEAU.

For years, Cammarata’s office and the federal government have received complaints of outrageous air ambulance bills.

“Between 2014 and 2018, between our office and the MIA [Maryland Insurance Administration], we had about two dozen complaints ranging from $12,300 to $52,000 for air ambulance transport services,” said Cammarata.

The federal Airline Deregulation Act barred states from regulating these services, now they can lean on new federal protections through the No Surprises Act.

“What it does is it protects consumers in a way that they’re only going to be responsible for paying their in-network cost share, so their in-network deductible, co-insurance, and co-pay and they cannot be balance billed,” said Cammarata.

Balance billing is when an out-of-network provider charges a patient the difference between what their health plan paid and the full amount of the service.

Under the No Surprise Act, once the patient pays their share, they have no further responsibility. The provider can then decide to go through a dispute resolution process with the health plan.

In addition to surprise out-of-network bills for emergency services, the protections apply to non-emergency services provided by out-of-network providers at an in-network hospital.

“You are going to deliver your first baby and your OBGYN is in-network with your insurance company, the hospital where you deliver is in-network with your insurance company, and then you go into the hospital, it’s time for that epidural you need the anesthesia, the anesthesiologist is out of network. You have no control over that,” Cammarata explained.

And Cammarata said these protections are long overdue.

“The problem was our laws could only apply to Maryland regulated plans, and about 70 percent of people are not in Maryland regulated plans, they’re in plans that are self-funded by their employers,” she said. “So, the federal law fills in a huge gap so we can definitely help more people. I mean it’s huge. It’s a big law.”

It also requires providers to give good faith estimates in advance of services. If the bill exceeds the estimate by $400 or more, then consumers can file a claim with the federal government to have an independent arbiter determine the payment amount.

The HEAU can help resolve medical billing or coverage disputes. If you think you’ve been balance billed, click here to get in contact with the agency.

Click here to learn more about the No Surprises Act and how it applies to patients.

And take the No Surprises Act quiz by the Kaiser Family Foundation to better understand the new federal protections.