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Co-op City Times / February 19, 2022
No Surprises Act Protects Individuals from Surprise Medical Bills BY BRANDON ORTIZ
A new law implemented last month protects individuals from incurring surprise medical bills. The new law, which is called the No Surprises Act, is two-fold. First, the law protects individuals who are covered under group or individual healthcare plans from receiving unexpected bills from providers who are not a part of the individual’s healthcare network. Second, the new law establishes an independent review process for individuals to dispute healthcare charges and provides dispute opportunities for uninsured or self-pay individuals who incur unexpected medical bills. Medicare and Medicaid recipients were the first demographics to have protection against surprise medical bills by law, and now that law has expanded to protect all consumers. Surprise medical bills can happen when an insured individual receives care from a facility or provider that is not a part of their healthcare coverage. The individual is then stuck paying more money for that care than they would have with an in-network provider because their provider will only pay a portion of the bill. Additionally, that same person could also be billed by the out-of-network provider for the difference between the total bill and the amount their healthcare plan already covered, which is a process called balance billing. Fortunately, under the No Surprises Act, balance billing is considered a surprise medical bill and individuals are therefore protected against such bills. Uninsured individuals or individuals who decide not to use their health insurance for a particular service can often ask for a good faith estimate up front of what that care will cost, according to the new law. If the final bill is $400 more than the original good faith estimate, then the individual has 120 days to file a dispute, also according to the new law. Below is a rundown of what kind of protections insured individuals can expect from the No Surprises Act: ● No surprise bill for emergency services, even if the service is an outof-network provider. ● No more out-of-network coinsurance or copayments for most emergency and some non-emergency services. Individuals also cannot be charged more than the in-network cost-sharing for services. ● No out-of-network charges and balance bills for specific services such as anesthesiology or radiology, which are sometimes administered by out-ofnetwork providers despite being inside an individual’s in-network facility.
● Health care providers and facilities must provide potential patients with easily accessible information regarding the patient’s billing protections and who to contact if the person feels that a provider or facility has violated their protections. Patient consent is also required to waive billing protections, meaning patients must both receive notice of and consent to balance billing. Individuals interested in learning more about the No Surprises Act can go online to cms.gov/nosurprises or call the Center for Medicare and Medicaid Services Help Desk at 1-800-985-3059. TTY users looking for more information can call 1-800-985-3059.
Co-op City Poet’s Corner By FRANK MAYES
Who Am I?
I suppose each of us at one time or another has asked the question, who am I? And what’s my purpose on life? Ok, let’s take a look; you’re not a doctor or a lawyer or the President of the United States. But do you cast a shadow on a sunny day? Do you see your reflection displayed in a mirror? If so, you are somebody. From the smallest insect in the forest to the largest whale in the sea, God created all of us with a purpose, to be involved. The clerk in the grocery store, the vagrant on the street, the jobless ones seeking employment. Remember we are all blessed in the image and the mental capacities of the greatest spiritual being that there ever was. Failure is not reaching for a goal and not succeeding, failure is not reaching. So if one door does not open, try another one. We are guided by our gift of “common sense,” so use it. If you learn just one thing every day, when you reach your “golden days,” you will be educated. It is written that education without common sense is like a ship without the ocean. So hold your head up high, know that you are like that one grain of grass needed with others to make a beautiful lawn.
Learning Ladder
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