How to Handle Surprise Medical Bills

Whether as the result of an automobile accident or work accident, personal injuries require prompt treatment. When accidents happen, your attention is focused on treatment and recovery while insurance coverage and cost take a back seat. With everything that happens following an accident, you may believe treatments were covered… only to receive a surprise medical bill months down the road. It is a common problem. When it happens to you there are steps you should take to protect yourself.

The Origins of Surprise Bills

Surprise medical bills can occur when individuals go to out-of-network providers, or when an in-network provider provides treatment not covered by an individual’s insurance policy. Many are the result of emergency room treatments provided by physicians, radiologists, and anesthesiologists who are not within the individual’s network plan.

Legislators Are Taking Action (Maybe)

Legislators in Washington are currently considering legislative proposals that would prohibit physicians from sending surprise balance bills to their patients. To curb the practice, legislators are considering “in-network guarantees” that would require reimbursement of emergency and ancillary care providers at in-network rates. Another option on the table is to create an independent dispute resolution process.

However, lobbyists for the healthcare industry argue that many emergency and ancillary care physicians will refuse to work with hospitals that pay below market rates. As a result of intense lobbying, it may be some time before congress takes active steps to resolve the issue through legislation.

In Colorado, the state legislature passed HB19-1174 earlier this year. When it goes into effect in January 2020, Coloradans with state-regulated insurance policies will have strong protections against surprise medical billing practices. These include prohibitions on “balance billing,” requirements for plain language informing patients of their rights, and establishing payment rates for out-of-network providers.

Dealing with Surprises

Individuals who receive surprise medical bills should consult with an attorney prior to making any payments or contacting the billing entity. An attorney can help review the billing statement, determine the legitimacy of the charges, and assess whether the requested amount falls within legal guidelines. Your attorney can also help communicate and negotiate with the medical care provider or help to file an appeal or a bad faith suit with the insurance provider.

For more about how to handle surprise medical bills, contact Sloat, Nicholson & Hoover, P.C. at (303) 447-1144. It’s our pleasure to help you identify the most effective method of handling and fighting surprise medical expenses.