Okay, this one is kind of a doozy - but it’s important!! Essentially, the No Surprises Act is intended to protect you, the individual receiving healthcare, from out-of-network surprise bills (ex: bloodwork, labs, tests, anesthesiology, specialists, etc.). Before the act, hospitals could bill you for an out-of-network cost without giving you a heads & you’d have to battle it out with the hospital & insurance (and many people would just end up paying it because… thats one way the healthcare industry makes $$$) But now, you have a bit more leverage. This act is mainly designed to help people in emergency situations, but, ironically doesn’t cover “ground ambulances” ?? Only “air ambulances” ?? Like helicopters? Ugh. Anywho, here are the technicals: The No Surprises Act (NSA) is a federal law that protects people from surprise medical bills. It went into effect on January 1, 2022 for most health plans, health systems, and hospitals. The NSA protects people from surprise medical bills in the following circumstances: 🚨Most emergency services 🏥 Non-emergency services from out-of-network providers at in-network facilities 🚁 Services from out-of-network air ambulance service providers 🛑 The NSA aims to limit the amount a person pays out of pocket to a level closer to what they would pay if the healthcare provider were in-network. The NSA defines this limit using a recognized market amount or qualifying figure, like the average fee for the service. 🤨 The NSA also makes it easier for people to understand the costs of health care services before they get a service (but obviously the last thing you’re thinking about when your femur is cracked in half from a car accident is “so how much is this going to cost me? Is this a network hospital?” We’ve got a long way to go with this backwards healthcare system - but hopefully the No Surprised Act can help more people advocate for themselves in the meantime. Not legal advice, just education. Not sure? Have questions? Need someone to talk to? Call the government Help Desk at 1-800-985-3059 (they speak 350+ languages!)
I broke my leg while snowboarding and my definite first thought was "how much is this going to cost?" Lol. I also crashed my car, and instead of realizing I had a neck injury, I was ranting to the tow truck driver that I was probably financially ruined because I knew what insurance wouldn't cover. It's totally a thing. 😮😢😅
Because of all that we are happy to have tax paid health care here in Denmark, no payment, zero, maximum payment for medicine is 660$ per year, I am happy for paying my taxes ❤
This happened to me for an MRI. I called my insurance company because they told me my insurance company refused to pay it. Long story short, my insurance company called them and told them they were reporting them for fraud. All the sudden I didn't have to pay for the MRI.
I've long suspected some medical and dental practitioners were committing fraud. I should've called my insurance company to verify these lies. It's so annoying
@@SL-lz9jr "Medical practicioners" dude, it's not the doctors/nurses that handle billing 😅 That's an entirely separate department made up of people that have absolutely zero training in healthcare. Corporate types, you know the type
@raerohan4241 that's not necessarily true. There are small / group practices and the doctors do some of that work. I know a surgeon that has to do it.
My wife works with medical and claims teams at an insurance company. Medical fraud is HUGE. Hospitals are constantly bending rules and sending wild bills and not communicating with insurance while they do it and usually they patients are not obliged to pay them but they get intimidated so much by collections that the hospital hires that they end up doing it. Then when the insurance company gets involved and makes them pay it back to the customer, they end up keeping the difference somehow often, and insurance companies end up losing money. I know insurance are frustrating but they don't want medical debt or ruined clients, they want them to be stable and able to pay without being overwhelmed. Hospitals do not give a fuck.
beware of the forms… If you’re scheduled for out-of-network care, a health care provider may ask you to sign a notice and consent form. Signing this form means that you agree to get care out-of-network and give up your protections from unexpected out-of-network bills.
My wife and I always sign that we are only responsible for our patient portion for in network services. Can’t tell you how many times we have called our insurance to out a sneaky Dr office.
All of your content is incredibly helpful and insightful but this one specifically will stick with me reall hard cause i feel like im always battling anything medical so thank you!
The no surprise act also applies if you don’t have insurance or choose to pay out of pocket. It requires providers to provide accurate good faith estimates and if they bill you more than 400 dollars over the estimate you can dispute it with CMS. Be warned that the process can be slow. I filed a complaint in October and it’s not resolved now in late February
This was something that actually happened to me(my parents, really) when I was 14. I had been having a LOT of stomach pain and it was getting worse. My mom took me to the hospital that was in network, but they were taking quite a bit of time to see me. They did labs and a pregnancy test, but that was it. My mom then drive me to my regular doctors she referred me to my surgeon. At this point it was about 5 hours since the onset of my symptoms, my surgeon examined me, felt around on my abdomen and was immediately concerned. He admitted me and I was in surgery with in the hour. It was my appendix and it had started to leak while I was on the table. I remember my mom talking to the insurance about the bill she got. They said that she took me to an “out of network” hospital (the one my surgeon practiced at) and that’s why they were not covering any of it. Well, she went on with them about how long the “in-network” hospital was taking, had the documents to prove the doctor there never saw me(I was parked in the main ER, but only in a wheelchair-they “couldn’t see me” unless I was in a”room”) and that they had basically left me there for 2 hours. She got the 😅insurance to process it as “in network”.
Such an American problem. I feel so bad for all you who have to deal with this stuff. I hope your country can catch up soon to the rest of the developed world. ❤
@@margaretwilson8736 Yes it’s clear that you don’t. If you did, you’d realize how the rest of the developed world has higher living standards, education standards, life spans, health standards, and safety standards. Open your eyes and realize that you can be more! You deserve more like the rest of us. Stay safe!
@@TheSwagtothefullest yes it’s very true that American medicine has changed the world! Sadly, most Americans cannot afford it. You deserve better like the rest of us! You can be better. Stay safe and happy!
Erin is the person teaching me how to be an adult when the Education system didn’t. I live in Canada so I don’t have to know about this specific topic but I definitely helped me learn a lot ❤
Insurance will cover everything but the pain killers.... That was my favorite from the dentists... Lesson learned ask about the insurance covering the pain killers in the procedures.
So an important detail to note is you ARE liable for paying up to 200% of your bill- say they gave you an estimate for $20 then billed you $100, you would be responsible for $40. You can tell the hospital to shove the rest and report them. This happened to me recently. The hospital gave me an estimate for $400 then charged me $8000. Turned their asses in :) Of course if they told you it would be $0, 200% is still $0 soo…. But PLEASE PLEASE have the estimate on paper. It makes it easier to prove it to CMS
Medical supply said my h2o machine was covered by my insurance. Insuranse changed, so the company who makes the mavhine tried charging me, even though new insurance was reported and covered the machine. Took a year to get it cleared up
um - no - what you will see is that if you ACCEPT care in their hospital, there will be a fine print clause that indicates out of network providers ARE your responsibility, especially if your insurance doesnt cover it. This will be sure for elective surgery, pre approved surgery and catastrophic procedures (probably not ER admits) wait for it, watch for it. (signed 20 years in the biz)
What about when the health insurance says that they will cover all of a specific service, minus a set copay, and then that service surprises you with a bill months later because that health insurance refused to cover the remaining costs? It was all in-network as well.
Away from this time there being a save. With regards to this chatacter being TOLD that something was the case. There is a saying in multiple languages that always bowls down to: "If it is not in writing, it did NOT happen!"
20k amestheisoligist bill means u were charged 1,200$ for local meds... get rid of insurance... itemitzed bills u will be charged 800$ for surgery and anesthesiology... but you paid $2400 for insurance from ur employer.... insurance is a HUGE scam....
Much easier when you live in a country with nationally funded health - no sugical costs at all. Scary concept for the US but it works for the rest of us.
every time i see something like this, i forget that you some places you have medical bills. how tf is someone supposed to dish out 20k for ONE THING let alone the usual 100k-200k medical bill?? i'd rather just reject the healthcare and die. im so grateful to be australian.
Its nice they passed such a law but it doesnt seem to get to the root cause of this which is that insurance companies have a stranglehold on medical care.
Americans, this is not normal, your healthcare should not have to be this expensive. It's not socialism to say that people should be able to stay alive without going 20 grand or more in debt. You shouldn’t need to know this because your bills should not be this high. Support universal healthcare, y'all.
Wow. I am so sorry for all the citizens of what seems to have become the United States of Scamerica. At least someone is trying to fix some of it, but that this act needed to be put in place in the first place is outrageous.
No…no…no…!! As soon as you confirm the charges are surprise billing tactics, report that medical provider to CMS! Don’t just accept that they’re going to work it out with the insurance. Report them immediately!!!!
@@poppyseeds439 I would suggest a lawyer at that point. One thing to point out too is that it would depend on when this happened. The law took effect in 2022. There are no statutes stating it will affect decisions made before then, thus, it is unlikely to do anything for you if you the bill was sent and paid before 2022
This is the first time that I've seen one of these financial tip shorts that's actually super useful for people outside of the top 10% of earners. We need more stuff like this
@@sharky2606nope trump is the exact reason everyones taxes came back completely messed up this year since they passed that tax bill in 2017. Trump only cares about his rich friends NOT YOU.
My son had an out-of-network ambulance ride in 2023. While I couldn't contest the entire bill, they charged $15 per mile in addition to their other charges. I ran the route they took on Google Maps and saw that they charged me for 10 miles when the route was only 9. I wrote them that I would only pay for 9 miles and told them to knock $15 off the final bill of about $350. Sucks but every bit counts.
I was an EMT for a private ambulance company. We document the mileage, but only from the odometer, which does not have a tenths place. So if the odometer was about to turn over another mile before your pickup, it could have added another mile. If it were up to me, I would reset the tripometer at the start of every trip and use that, but instead the odometer is used because the Departments of Weights and Measures certifies the odometer and gives it the same sticker gas pumps have.
@@jerradwilson Doesn’t the trip meter just use the odometer? There’s also a lot of certified solutions for this type of thing, commercial fleet tracking equipment does, which if a company doesn’t have fleet tracking on an ambulance I would be questioning their business practices. This type of equipment/software can hit the vehicle ODS and get the mileage, log it automatically and do gps tracking to log the route in case it gets questioned. Usually it will integrate with whatever dispatch software is used as well so that when someone goes enroute to an incident/event it can be triggered automatically, and when closed out the data can be automatically included in reports. Cab companies also have meters that need to be certified too and pretty much do exactly what is needed here.
@@NickSteffen I worked for the ambulance company 20 years ago, so things may be different now. The tenths place on the trip meter is independent of the odometer. For example, the ambulance may have traveled 9/10ths of a mile by the time it's gotten to a pickup. If I reset the trip meter, then the odometer will be 9/10ths of a mile ahead of the trip meter, so if the trip is 8½ miles, the odometer will show 9 miles, but the trip meter will show 8.
.... out of network private ambulance services is just..evil.. Why are people so damn greedy that they start overcharging with ridiculous fees to save a damn human life? The healthcare system is so broken im starting to believe its always been planned to be this way..
Yep! This is a very common tactic. I got a $5k bill in the mail from an anesthesiologist after a surgery. I was told this by the anesthesiologist . I filed a claim with my insurance company and told them that the hospital was in network and I was not given a choice of anesthesiologists. Never heard a peep from the anesthesiologist again. 😊
A recent article noted that since this act went into effect, a few anesthesiology and laboratory organizations have shut down. They've been relying on this practice for years.
Had a similar issue, called the hospital accounts office with my insurance on three way...after I informed them I had insurance on the line, we had a 10 minute wait on hold, then the clerk came back saying they were going to take care of it on the provider side...never saw another bill. Including the $200 I still owed them for my copay.
@@InsightfillIt’s insane because in our own healthcare system, we are dealing with literal scams. These people literally work to scam you and that’s how their companies get their money. That is baffling to me.
This happened to me twice where my network hospital used out of network anesthesiologists. The first time I was freaked out. It took a lot of digging and insistence on my part to get it resolved. Hospitals blame the providers, the providers blame the insurance companies, and the insurance companies blame anyone they can. The 2nd time it happened I knew the score. I made one phone call, mentioned the No Surprise Billing Act, and never heard from them again! 👍🏻
"we dont have time for all that" "See that isnt my problem, you had the time to send me the bill clearly. You can send another one for sure." Id report them anyway
Advice from someone who works in healthcare: -The No Surprised Act requires hospitals and doctors to provide estimates on procedures to patients. They are also required to send a written copy to you so if you ARE surprised, you have the documentation to prove it. You shouldn’t have to request it but make sure you know your rights. -It used to be that the place recommending the procedure was required to get an all in one estimate for the patient for their fees, hospital, and anesthesia. That was amended in 2023. Now, you as the patient have to call the individual places for those numbers. (Doctors, hospitals, and anesthesia usually have their own bills and RARELY share it with patients let alone each other.) -To make things easier for estimates, ask the doctor and preregistration for the CPT codes associated with your procedure. There are multiple codes for MRIs, CAT scans, and more so having the exact one is IMMENSELY helpful and more accurate. (Make sure to talk to preregistration especially. I have had instances where I have received one code only to find three more added to the encounter because doctors usually do not know medical codes. That is what coders do and they know if there are affiliated codes for that procedure.) -Also have the facility handy. Some facilities cost more than others and to be as accurate as possible, have that on hand. -Some hospitals are able to give you an estimate for the hospital fees with your insurance details. Having those on hand is helpful as well. -Check for Financial Assistance and Payment plan options. (Some hospital systems have both and others only do payment plans.) And when applying for charity, send your application via every method you can think of to make sure the hospital gets it. You can even ask for an application when scheduling and apply before you even have the procedure done. -If you see anything that goes against the No Surprises Act, report it. You can threaten to make sure they get their butts in order but do not let it slide just because they corrected your bill. It will leave a history that will lead to corrective action in the future.
Another thing to remember: Don’t just ask if they “take” your insurance. Ask if the are in network. They can be out of network and take your insurance. You ARE responsible for the balance billing if you ask if they take your insurance. Got to love our messed up health insurance system.
Exactly. It's not up to the doctor to decide if the insurance company will pay. It's up to the insurance company to decide if they will pay. They should be the first call you make, not the doctor's office.
I got a bill for $700 for bloodwork. My main problem with medical billing disputes is that it is extremely difficult to even talk to anyone. They say call this number and when you do it's an automated message that says leave your name and number and we'll get back to you. But they NEVER call!
Document time, date, and disposition of every call in attempt to resolve. Let them send you to collections. When the collections company starts calling tell them verbally and in writing, that you have no business with them and to stop calling (there are attorneys that will give you great advice and forms for just this, cheap). You business is with "xyzzy Medical Co". You only talk with them. Contact your insurance company. Most importantly, keep good records. Keep up with who and what your insurance has paid out. If a lab initially charges $700 for the bloodwork you are having done, but your insurance company and lab have agreed to $200 for that lab work, that lab may likely send you a bill for the $500 that the insurance didn't't pay, but the lab agreed to the $200 with the insurance company. Most people don't even question this, they just pay it. Contact your insurance company immediately and don't pay that bill until you find out you owe that for sure. Likely it's just a bait. If you pay it, great! (most of us want to pay our bills). If you don't pay it, they may threaten collections, may even initiate collections. Don't fall for it. Check with your insurance company BEFORE you pay that bill. Likely your insurance has paid the agreed upon price. The insurance company works for you!
When that happens to me I start calling and leaving messages one right after the other and my last message says this, “ if I do not hear from you within the week I will know this bill is null and void and you have resolved this issue internally. “ Then I make notes on days and time and exactly what was said by me.
Be careful not to sign any papers agreeing to pay OON charges. Also, hospitals have entire billing departments designed for billing. They have so much time.
When my mom was in the hospital they handed her a piece of paper with minuscule writing on it telling her about the out of network doctor. They made it sound like if she didn't sign she wouldn't get care. You couldn't even read it it was such small font.
Can I refuse it? Im quite sure all my appointments anywhere has required me to sign something like that, or refuse me service. The document 1 paragraph just says that if insurance doesnt cover, I'm required to pay.
Go ahead and sign, the act makes these types of "contracts" not hold up and unenforceable. Source: I had to deal with a hospital doing this to my wife and son, don't owe the out of network anymore.
I work with insurance!!!! Definitely inform the doctors to send this claim to the insurance 9/10 the insurance will inform the doctors that they will have to write off the charges, and since it's an in network facility they're contacted to do so!!!!! Always call insurance for clarity on claims processing! Erin = 💯
Another Pro tip: if you have a choice, never get expensive imaging done at the hospital. There are freestanding radiology clinics that charge a fraction of what hospitals do for MRIs, CT scans, etc. Just tell your physician you want a printed order (yes, on paper), and take it to the radiology clinic. They will bill your insurance for a lot less, which will lower any patient portion you may owe (deductible, co-insurance).
@@lb5358 - so sorry; if it ever happens again (hopefully never), contact NPR. They have a group within them that can call out and shame predatory healthcare providers- and get the bill substantially reduced. Or, contact a healthcare journalist at a major publication. Negative publicity is a powerful thing:
We have no choice. We elect politicians who are supposed to fix it for us. It’s not like they don’t know it’s broken. Too much money involved and lobbyists.
@@cconnon1912 it just shows how starkly the US is not a democracy. Because if everyone hates it, it should be possible to change it. But it seems no one wants to, or the other option is that you don't actually live in a democracy.
I did this in 2001. I was in a hospital that was a provider with my insurance. Weeks later I get a bill. I called and they said their in house laboratory was not a provider for my insurance. I refused to pay told them I was getting a lawyer. I was also going to report them to the appropriate government agency and insurance commissioner for my state. I also told them that if they were right and I had to pay they would receive 5 dollar payments until the money was paid off. Somehow I never got another bill. 😂
Also- always always always ask for an itemized bill! The costs tend to magically go down when they have to admit to charging $100 for a bandaid in writing. Edit: THIS IS FOR IF YOU ARE PAYING OUT OF POCKET FOR CARE. Thank you to the person who reminded me of this in the replies!
When I had my son by c-section last year, I couldn’t wait to leave that horrible hospital. The mother-baby room was disgusting, and all night long, every 2 minutes, my broken IV pump beeped because it was malfunctioning, oh, and the patient in the room next to me had Covid, so I could hear her hacking through the wall and there was a PPE / Droplet Precaution sign on her door. Yuck. I couldn’t wait to leave. I had him at 5 on Friday, and by the Sunday morning, I was ready to get out of there. I asked the doctor during morning rounds if I could leave. She told me that was fine and that she would start on my discharge paperwork. Hours went by, and I asked every nurse that came in my room, but no one knew what was taking so long. Finally, around 5 PM, I was so annoyed with still being there, and having asked so many times, that I just started packing up my stuff because I was going to just walk on out of there. and nurse finally came in and angrily handed me paperwork to sign and do you know what? When bills started coming in a couple of weeks later, I learned I had been charged for an extra day because I was there past 3pm. That was THEIR fault, against my will. 🙄
@@sayhello5377 Imagine living in one of the only western country without public healthcare, saying private is best, then constantly see those stories beibg passed around.
@@arakwarno one, not one single normal person in this country thinks that private healthcare is best. What people in government positions say is totally out of touch with what most people here actually think. We all know our healthcare system is crap! And those that advocate FOR it, are not affected by it.
How do you solve for the fact that the effective tax rate would sky rocket for people who generally take care of themselves? Most medical services are for lifestyle choices including obesity.
More like incompetent. There's also a huge disconnect in hospitals that allow outside providers to practice because they cannot speak to the contract status of those providers. The hospital system I work for only allows a couple outside surgeons to practice at one OR suite. If this happens it's on those surgeons to eat the costs for not communicating their participation status to their patient. Otherwise, all contracts are the same for our hospitals & physicians.
Please also pay attention to paperwork you are signing before going into a procedure. They could slip in a form where you acknowledge that an “-ologist” is out of network and give consent to it by signing… and then there is no legal recourse you can take since you “signed off” on it.
It depends. If they gave you drugs before giving you the paperwork, then you weren't mentally competent to agree. Even if that's not the case, you're signing under duress, which is also illegal.
While I agree for the most part, I have been sent to some sketchy doctors and would never agree to have my pet cockroach to a doctor like that. So if one gets sent to a doctor you are not comfortable with, say something. I was sent to a new arthritis doctor. Nope, no way. I went to the referring office and said nope, no way, next . . . One has to advocate for yourself. Not fun but necessary.
@@naomiemoore5725 Now imagine that all other doctors are « out of network ». Ylu’d be stuck with that bad doctor. Being insured should mean being covered.
@@arakwarYes, I have dealt with that too. I rarely settle with a doctor that I can't work with. Hence searching for a new one, yet hanging on to the current one until established elsewhere so there is no gap obtaining my current medication.
Maybe at hospitals, but private practices sometimes don't even want to deal with insurance. They just take a flat rate for the year for you to see them.
@@carlac4407 me too. A friend of mine was telling me about the $10,000 bill for delivering her baby in the US (this was about 16 years ago) and I was freaking out thinking that it was a really problematic birth with heaps of complications and life saving interventions. Turns out it was just a normal birth 😮
I'm so glad I don't live in the US 😂 it sounds wild. No healthcare, horrible education, school shootings and gun lovers, racism and horrible rights for women, and people going crazy to put a criminal person on the throne another 4 years. 😬 The list keeps getting longer
@Nathan_Bookwurm only cause we sold it to you. Not just Healthcare, but military and industry funding as well. If we backed out of our trade agreements, you'd be back to offering alcohol for pain relief. Don't bite the hand that feeds you
@marty8722 dude no. The rest of the world is doing just fine medicine wise. The USA might produce the most but it's not even close to being the most per capita. Also it's not like all medical research or advancements take place there. I mean the first heart transplant took place in South Africa. Other developed countries are usually just smaller. Also the US has a practice of making minor tweaks to drugs to keep their patents so that they can make more money which they count statistically as "making new drugs" so that's why it looks like they produce the most. It's just a gift. New drug development is a collaborative effort between universities globally, it's not something one big company does. They just take that primary research, tweak it and then patent it. The rest of the world is doing just fine thanks. Get off your American supremacy soap box.
@@sneakylemon8513 Furthermore, the US medical industry is not working to better the health of Americans. Just think about the opioid crises which already cost thousands of lifes. This was caused by American pharmaceutical companies developing this highly addictive pain-killers and pushing doctors to describe them. That kind of US innovations we rather go without.
Providers can also rite off charges if it's out of network. I worked in insurance. Providers will often send out the full bill because ( sadly) alot of people won't challenge it and just pay to avoid the time and hassle of calling to inquire. Thank you for sharing this with consumers.
This is false. The providers don’t bill patients if the provider is an employee of the hospital, the hospital is responsible for billing/receiving money from the insurance. It’s not a provider’s job to research YOUR insurance specifics and see if they are in network or out of network for a patient-it is the hospital and patient’s job!! Jesus christ.
Interesting! In 2018 my son was burning leaves and caught one hand on fire. 2nd degree burns. Rushed him to the nearest ambulance station and they took him to the closest hospital an hour away. They then referred us to the closest burn clinic which also was an hour from home.. It was via the Mercy hospitals and we used Mercy clinic all the time, but all the same I asked the clerk at check-in if our visit required pre-authorization. She assured me that they took our insurance and were in-network. When the nurse took us back, I again asked her. She assured me the same. When the Dr came in, I again asked him. He asked who my insurance was and said oh yes, no problem. About 10 months later we got a huge bill. I fought it for 18 months. The Dr even wrote a letter stating that he remembers me asking and he assured me he was in-network. My insurance company didn't care. They kept insisting I owed it. Exhausted, and worried about a tarnished credit score, I finally just paid it. 😢 The insurance told me the closest burn center near me was in Tennessee or Oklahoma (I don't remember now) but it was a 6 hour drive away! They even told me that they would have pre-authorized it IF ONLY THE BURN CENTER HAD CALLED. 😮 I kept saying Ok, and how is that MY FAULT? I'm a lay person. How am I supposed to know how to do their job? And I'm sure the clerk would agree that I asked if we need pre-authorization. Ridiculous!!!!
@@cita_m people like this live for that one letter error and the chance to exert their thought of perception of superiority. However, it is truly obvious who's the fool.
When I was preparing for my surgery at the end of November, I called my insurance company and specifically asked this question. My insurance company told me that if I did receive a full payment bill for any of the "extras" like anesthesia, pathology etc to call them because you don't get to choose those and they HAVE to cover them. They did the same thing for the ambulance company when I made a 911 call, they weren't in network but I didn't get to choose when calling 911 so they covered it anyway.
This exact thing happened to me in 2016. Emergency surgery at in-network hospital, then received statements from insurance provider which showed the anesthesiology charges were not being covered by my insurance. I started making phone calls to the hospital and insurance provider and finally got the name and phone number of the company that provided the out-of-network contract anesthesiologist for my surgery. I called them with questions about my bill (which I had not yet received), and they could not even find my name or any relevant information in their system. I made it clear to that anesthesiology company, the hospital, and my insurance provider that I had no intention of paying out-of-pocket for something that was clearly supposed to be covered in-network, especially as I was not informed before the surgery that the hospital was using an out-of-network contract anesthesiologist. I never received a bill from the anesthesiologist and never heard anything else regarding the issue from the hospital or my insurance provider.
I went to an urgent care that was covered by my insurance but they had to do imaging for me that needed preauthorization that I wasn't told about until after and the CT scan/ imaging was done, the imaging was done in a different section of the building that was connected to the urgent care that was a hospital that was not covered by my insurance. Luckily, the hospital covered my bill because I qualified for low income forgiveness, but I would have been stuck with a $10,000 bill. I don't know if there is any law that hospitals or urgent cares need to tell people about this, but it's important if they want to move you or do imaging that you make sure you call and talk to your insurance company beforehand or have a loved one help you. I've been in agonizing pain on the phone with my insurance. Better yet call your insurance and figure out the hospitals closest to you that you can get in network coverage and ask your insurance what needs preauthorization, so you are ready in an emergency. Our healthcare system is awful, I'm so glad this law was passed, I have always been fearful of this and having to demand that I only get in network coverage.
When you turn 65 pay for the supplement rather then getting the Advantage plan. If you choose the Advantage plan you will have to get referrals for treatment. With the supplement you avoid referrals. Especially avoid the Advantage plans advertised on tv by old sports figures and actors, the companies they represent are infamous for denying coverage. Advantage plans are great for those that never have health issues but terrible for those that get serious health problems.
I’m from the UK and this makes me realise how important the NHS is and how much it needs to be fixed. I cannot imagine being unwell and having to worry about insurance and asking the right questions and getting bills. I’m 36 and never been billed for anything health wise (except minimal dental charges which are also mostly NHS covered). Even our prescription medication is ‘free’ in Scotland. I know we might pay national insurance but it’s so worth it to me to not have these worries for me or my family.
So many people want a system like that but I honestly think it would be a nightmare if we tried to implement it here. Our population is so huge and our border is also wide open. Our politicians are giving credit cards to illegals ffs. They don't know how to run anything and many of us are very wary of handing the reins to them when it comes to our healthcare. We have to come up with a better system though bc this is so completely fucked.
@@alwaysannoyed11 well you're clearly uneducated on that topic. We have more illegals pouring in than any country in the world and no, they are not contributing more than the average citizen. The vast majority are a drain on the system.
@@119beaker Yes I'm aware. The system is definitely broken but clearly the government doesn't know how to fix it which is why I wouldn't want them to retain complete control over it. We don't need to give them any more access to our money than they already have.
Hospitals already have a workaround: if you are going there for non-emergency services, they’ll have you sign a document that basically says that they work with multiple providers, some of which might not be in network. It will also have language saying that, while they try to do what they can, they make no guarantee nor assurance that all providers that provide their services to you will be covered in network. One thing to understand is that very few doctors that work at hospitals these days work for the hospital; they have a contract with the hospital to work there. This leaves them open to have separate agreements with the insurance companies.
They will screw us one way or another because finding people to actually pay a bill is getting harder with inflation going crazy. No one can afford healthcare, even with insurance. Senior citizens especially.
Nevada passed a law just recently that says it's not the responsibility of the medical offices, hospitals, or insurance companies to inform you whether or not someone is in network. It is the patient responsibility to call and confirm with their insurance that a medical professional is in network. So fun.
Yeah, crazy that you have to have a modicum of responsibility to be literate on the specific insurance benefits YOU are paying one of dozens of insurance companiesTHOUSANDS of dollars per year to receive! Nitwit.
The healthcare/ insurance system in the US is odd and very pricey. Im living in the Philippines, low middle class, got a job, im insured both nationally and a private one. 2015. I had an emergency surgery due to acute appendicitis. I chose a private hospital cuz i trust them better. Anyway. I had one of these bad luck time where most of the anesthesiologists are attending a seminar and the one who anesthetize me isnt covered by my private insurance. Though it is somewhat a surprise i only had to shell out almost 200 usd to pay the anesthesiologist. But compare 200 to 2000 or 20 000 usd? Why so much US?
Unchecked capitalism and greed. The love of money is the root of all evil, and that's what runs our country. I so wish I didn't have to worry about whether I can afford my health insurance, my medication, or the doctor visit and just go get things done.
I totally agree, but also, if you are in the Lord, it's all for the Lord aka the Lord's work. Ecc 5:9 whatever your hand finds to do, do it with all your might ❤
Also, to see if they’re overcharging you, you can ask for an itemized bill and they are required to give it to you. It lists everything you got and had done and how much each thing costs individually.
Used to work at BCBS... Just FYI, there are no in-network anesthesiologists. They know they're necessary for surgeries and procedures and can get away with being out of network. YOU'VE BEEN WARNED
They can still surprise bill you for in-network though. I got saddled with a $3500 copay when they never told me I would have hospital costs associated with a service I received at the doctors office, they only told me about the doctor costs
That is probably from your insurance plan. I work for a hospital system and we cannot bill anything other than what the insurance tells us to bill the patient. Call your insurance and ask why they applied such a huge deductible to that one procedure.
Yeah. When I went to the er trying to figure out if my water broke, I got a bill back saying the test they did for amniotic fluid "was not approved by the FDA" and there for was not covered by my insurance. I ended up having to spend almost two months going back and forth between my insurance and the hospital demanding each bill be checked for proper coding. For the 4 total visits I had at the OBED ER, they were asking nearly $9,000 (which not to sound spoiled, but we have damn good insurance and should not have been charged more than $200 total for all 4). I stuck to my guns and made them refile everything. Now, almost 8 months later, I got notified the bills were paid in full. If something doesn't seem right, it probably isn't. Fight for your money.
As someone who has worked in medical billing, the hospital or doctor are usually very willing to talk to the insurance about a medical bill since they get paid more than if they had to negotiate a patient rate.
![[TH] FS vs BME - VCT Ascension Pacific - Lower Bracket Final](http://i.ytimg.com/vi/wnygqsR2Fig/mqdefault.jpg)
Okay, this one is kind of a doozy - but it’s important!! Essentially, the No Surprises Act is intended to protect you, the individual receiving healthcare, from out-of-network surprise bills (ex: bloodwork, labs, tests, anesthesiology, specialists, etc.).
Before the act, hospitals could bill you for an out-of-network cost without giving you a heads & you’d have to battle it out with the hospital & insurance (and many people would just end up paying it because… thats one way the healthcare industry makes $$$)
But now, you have a bit more leverage. This act is mainly designed to help people in emergency situations, but, ironically doesn’t cover “ground ambulances” ?? Only “air ambulances” ?? Like helicopters? Ugh.
Anywho, here are the technicals:
The No Surprises Act (NSA) is a federal law that protects people from surprise medical bills. It went into effect on January 1, 2022 for most health plans, health systems, and hospitals.
The NSA protects people from surprise medical bills in the following circumstances:
🚨Most emergency services
🏥 Non-emergency services from out-of-network providers at in-network facilities
🚁 Services from out-of-network air ambulance service providers 🛑 The NSA aims to limit the amount a person pays out of pocket to a level closer to what they would pay if the healthcare provider were in-network. The NSA defines this limit using a recognized market amount or qualifying figure, like the average fee for the service.
🤨 The NSA also makes it easier for people to understand the costs of health care services before they get a service (but obviously the last thing you’re thinking about when your femur is cracked in half from a car accident is “so how much is this going to cost me? Is this a network hospital?”
We’ve got a long way to go with this backwards healthcare system - but hopefully the No Surprised Act can help more people advocate for themselves in the meantime.
Not legal advice, just education.
Not sure? Have questions? Need someone to talk to? Call the government Help Desk at 1-800-985-3059 (they speak 350+ languages!)
I love your channel ❤ I learn such great stuff
THANK YOU!!!!
I broke my leg while snowboarding and my definite first thought was "how much is this going to cost?" Lol. I also crashed my car, and instead of realizing I had a neck injury, I was ranting to the tow truck driver that I was probably financially ruined because I knew what insurance wouldn't cover. It's totally a thing. 😮😢😅
It eould be a lot easier just to make those networks illegal. You’re insured, then your insurance pays.
Because of all that we are happy to have tax paid health care here in Denmark, no payment, zero, maximum payment for medicine is 660$ per year, I am happy for paying my taxes ❤
This happened to me for an MRI. I called my insurance company because they told me my insurance company refused to pay it. Long story short, my insurance company called them and told them they were reporting them for fraud. All the sudden I didn't have to pay for the MRI.
I've long suspected some medical and dental practitioners were committing fraud. I should've called my insurance company to verify these lies. It's so annoying
@@SL-lz9jr "Medical practicioners" dude, it's not the doctors/nurses that handle billing 😅 That's an entirely separate department made up of people that have absolutely zero training in healthcare. Corporate types, you know the type
@raerohan4241 that's not necessarily true. There are small / group practices and the doctors do some of that work. I know a surgeon that has to do it.
My wife works with medical and claims teams at an insurance company. Medical fraud is HUGE. Hospitals are constantly bending rules and sending wild bills and not communicating with insurance while they do it and usually they patients are not obliged to pay them but they get intimidated so much by collections that the hospital hires that they end up doing it. Then when the insurance company gets involved and makes them pay it back to the customer, they end up keeping the difference somehow often, and insurance companies end up losing money. I know insurance are frustrating but they don't want medical debt or ruined clients, they want them to be stable and able to pay without being overwhelmed. Hospitals do not give a fuck.
@@raerohan4241Doctors and Psychiatrists constantly are involved in billing what are you on about.
beware of the forms… If you’re scheduled for out-of-network care, a health care provider may ask you to sign a notice and consent form. Signing this form means that you agree to get care out-of-network and give up your protections from unexpected out-of-network bills.
Which is why every damn kid that comes out of school nowadays that cant read is a BIG problem..
Glad I live in Oz and Medicare / Private covers all expensive - sometimes a small gap
My wife and I always sign that we are only responsible for our patient portion for in network services.
Can’t tell you how many times we have called our insurance to out a sneaky Dr office.
If you don't sign it can they turn you away for services?
All of your content is incredibly helpful and insightful but this one specifically will stick with me reall hard cause i feel like im always battling anything medical so thank you!
Thank you, Erin! This is such empowering information!
Erin! I used this on my doctor a few weeks ago!! THANK YOU!!!
The no surprise act also applies if you don’t have insurance or choose to pay out of pocket. It requires providers to provide accurate good faith estimates and if they bill you more than 400 dollars over the estimate you can dispute it with CMS. Be warned that the process can be slow. I filed a complaint in October and it’s not resolved now in late February
Never knew you can report them. This is awesome news for the future.
THANK YOU. This needs so much more exposure
Awww🥰...you’re such a blessing, without a doubt!
I'm glad these channels exist. One of the biggest crimes against the American people is that we are left ignorant of our rights.
This was something that actually happened to me(my parents, really) when I was 14. I had been having a LOT of stomach pain and it was getting worse. My mom took me to the hospital that was in network, but they were taking quite a bit of time to see me. They did labs and a pregnancy test, but that was it. My mom then drive me to my regular doctors she referred me to my surgeon. At this point it was about 5 hours since the onset of my symptoms, my surgeon examined me, felt around on my abdomen and was immediately concerned. He admitted me and I was in surgery with in the hour. It was my appendix and it had started to leak while I was on the table. I remember my mom talking to the insurance about the bill she got. They said that she took me to an “out of network” hospital (the one my surgeon practiced at) and that’s why they were not covering any of it. Well, she went on with them about how long the “in-network” hospital was taking, had the documents to prove the doctor there never saw me(I was parked in the main ER, but only in a wheelchair-they “couldn’t see me” unless I was in a”room”) and that they had basically left me there for 2 hours. She got the 😅insurance to process it as “in network”.
Such an American problem. I feel so bad for all you who have to deal with this stuff. I hope your country can catch up soon to the rest of the developed world. ❤
Aww thanks - you may feel bad for us but we don't think about you at all. ❤
Yet everyone copies American medicine
@@margaretwilson8736 Yes it’s clear that you don’t. If you did, you’d realize how the rest of the developed world has higher living standards, education standards, life spans, health standards, and safety standards. Open your eyes and realize that you can be more! You deserve more like the rest of us. Stay safe!
@@TheSwagtothefullest yes it’s very true that American medicine has changed the world! Sadly, most Americans cannot afford it. You deserve better like the rest of us! You can be better. Stay safe and happy!
@@TheSwagtothefullest But not American medical billing scams.
Erin is the person teaching me how to be an adult when the Education system didn’t. I live in Canada so I don’t have to know about this specific topic but I definitely helped me learn a lot ❤
Ugh! wish i would've known this last year 😭
Insurance will cover everything but the pain killers....
That was my favorite from the dentists...
Lesson learned ask about the insurance covering the pain killers in the procedures.
So an important detail to note is you ARE liable for paying up to 200% of your bill- say they gave you an estimate for $20 then billed you $100, you would be responsible for $40. You can tell the hospital to shove the rest and report them. This happened to me recently. The hospital gave me an estimate for $400 then charged me $8000. Turned their asses in :)
Of course if they told you it would be $0, 200% is still $0 soo….
But PLEASE PLEASE have the estimate on paper. It makes it easier to prove it to CMS
Medical supply said my h2o machine was covered by my insurance.
Insuranse changed, so the company who makes the mavhine tried charging me, even though new insurance was reported and covered the machine.
Took a year to get it cleared up
Now tell them about the ambulance one in CA!!
um - no - what you will see is that if you ACCEPT care in their hospital, there will be a fine print clause that indicates out of network providers ARE your responsibility, especially if your insurance doesnt cover it. This will be sure for elective surgery, pre approved surgery and catastrophic procedures (probably not ER admits) wait for it, watch for it. (signed 20 years in the biz)
What about when the health insurance says that they will cover all of a specific service, minus a set copay, and then that service surprises you with a bill months later because that health insurance refused to cover the remaining costs? It was all in-network as well.
This is so dystopian to anyone outside the US, it feel like another timeline where the corporation owns you.
The health insurance companies have blood on their hands
I’m so glad I live in Sweden! 😅
First of all NO doctor should be considered out of ANY insurance network.
If the provider doesn't get authorization from insurance. The provider has to eat the cost
Away from this time there being a save.
With regards to this chatacter being TOLD that something was the case.
There is a saying in multiple languages that always bowls down to: "If it is not in writing, it did NOT happen!"
Thank you.
This is good to know.
It's disgusting that they even try to do this. Thank God for universal healthcare.
20k amestheisoligist bill means u were charged 1,200$ for local meds... get rid of insurance... itemitzed bills u will be charged 800$ for surgery and anesthesiology... but you paid $2400 for insurance from ur employer.... insurance is a HUGE scam....
Much easier when you live in a country with nationally funded health - no sugical costs at all. Scary concept for the US but it works for the rest of us.
Hospitals don’t bill for the physician charges.
The exact same thing has happened to me
They tried to charge me 22g for a surgery that was approved 💀💀💀💀
You can report all you want to CMS ttad and trep they will still bill you
every time i see something like this, i forget that you some places you have medical bills. how tf is someone supposed to dish out 20k for ONE THING let alone the usual 100k-200k medical bill?? i'd rather just reject the healthcare and die. im so grateful to be australian.
Its nice they passed such a law but it doesnt seem to get to the root cause of this which is that insurance companies have a stranglehold on medical care.
America is wild!!!!!!
Oh damn, now I know what I need to do for $1k bill I can't afford.
Americans, this is not normal, your healthcare should not have to be this expensive. It's not socialism to say that people should be able to stay alive without going 20 grand or more in debt. You shouldn’t need to know this because your bills should not be this high. Support universal healthcare, y'all.
And then your insurance says they wont cover it and your house is gone
Oh that's quite exciting
Wow. I am so sorry for all the citizens of what seems to have become the United States of Scamerica.
At least someone is trying to fix some of it, but that this act needed to be put in place in the first place is outrageous.
Wish this was a thing when I got my kidney stone removed
THANK YOU!!!!!!! Bye bye $3000 ambulance ride
What would we do without Erin?! XD
Amen.
Facts
Hospital has to eat it!!
❓Is this just in the US? Or other countries have it too?
Being an American is so weird, I can't even imagine having to worry about stupid shit like medical bills which could bankrupt me
Yet the Nth reason you need Universal Healthcare like the rest of the developed world. #LastWorldHealthcareUSA
imagine your inshurence dosnt cover everything you need in order to stay healthy
No…no…no…!! As soon as you confirm the charges are surprise billing tactics, report that medical provider to CMS! Don’t just accept that they’re going to work it out with the insurance. Report them immediately!!!!
This! Report them for doing what they know is wrong but they just don't care and are trying to get more money out of you.
What if my dad already paid the bill because he didn't know about this law? Can I go back and get the money back if the hospital tried this?
@@poppyseeds439 yes! Contact the insurance company and review the explanation of benefits (EOB).
@@poppyseeds439he should try. Unless he’s a millionaire that’s a lot of money
@@poppyseeds439 I would suggest a lawyer at that point. One thing to point out too is that it would depend on when this happened. The law took effect in 2022. There are no statutes stating it will affect decisions made before then, thus, it is unlikely to do anything for you if you the bill was sent and paid before 2022
This is the first time that I've seen one of these financial tip shorts that's actually super useful for people outside of the top 10% of earners. We need more stuff like this
This is so incredibly important that people know this!
Vote in Trump, and it'll be like this never existed
@@sharky2606and why is that?
@@sharky2606keep going with sleepy joe and well have even more debt to never pay off 😊
@@sharky2606nope trump is the exact reason everyones taxes came back completely messed up this year since they passed that tax bill in 2017. Trump only cares about his rich friends NOT YOU.
I don't give a s***! Sincerely, from Europe❤
My son had an out-of-network ambulance ride in 2023. While I couldn't contest the entire bill, they charged $15 per mile in addition to their other charges. I ran the route they took on Google Maps and saw that they charged me for 10 miles when the route was only 9. I wrote them that I would only pay for 9 miles and told them to knock $15 off the final bill of about $350. Sucks but every bit counts.
I was an EMT for a private ambulance company. We document the mileage, but only from the odometer, which does not have a tenths place. So if the odometer was about to turn over another mile before your pickup, it could have added another mile. If it were up to me, I would reset the tripometer at the start of every trip and use that, but instead the odometer is used because the Departments of Weights and Measures certifies the odometer and gives it the same sticker gas pumps have.
@@jerradwilson Thanks for the explanation! They didn't fight me on the $15.
@@jerradwilson Doesn’t the trip meter just use the odometer? There’s also a lot of certified solutions for this type of thing, commercial fleet tracking equipment does, which if a company doesn’t have fleet tracking on an ambulance I would be questioning their business practices. This type of equipment/software can hit the vehicle ODS and get the mileage, log it automatically and do gps tracking to log the route in case it gets questioned. Usually it will integrate with whatever dispatch software is used as well so that when someone goes enroute to an incident/event it can be triggered automatically, and when closed out the data can be automatically included in reports.
Cab companies also have meters that need to be certified too and pretty much do exactly what is needed here.
@@NickSteffen I worked for the ambulance company 20 years ago, so things may be different now. The tenths place on the trip meter is independent of the odometer. For example, the ambulance may have traveled 9/10ths of a mile by the time it's gotten to a pickup. If I reset the trip meter, then the odometer will be 9/10ths of a mile ahead of the trip meter, so if the trip is 8½ miles, the odometer will show 9 miles, but the trip meter will show 8.
.... out of network private ambulance services is just..evil..
Why are people so damn greedy that they start overcharging with ridiculous fees to save a damn human life? The healthcare system is so broken im starting to believe its always been planned to be this way..
Yep! This is a very common tactic. I got a $5k bill in the mail from an anesthesiologist after a surgery. I was told this by the anesthesiologist . I filed a claim with my insurance company and told them that the hospital was in network and I was not given a choice of anesthesiologists.
Never heard a peep from the anesthesiologist again. 😊
A recent article noted that since this act went into effect, a few anesthesiology and laboratory organizations have shut down. They've been relying on this practice for years.
@@InsightfillGOOD! They should not be allowed to operate this way. It’s wrong.
Had a similar issue, called the hospital accounts office with my insurance on three way...after I informed them I had insurance on the line, we had a 10 minute wait on hold, then the clerk came back saying they were going to take care of it on the provider side...never saw another bill. Including the $200 I still owed them for my copay.
@@InsightfillIt’s insane because in our own healthcare system, we are dealing with literal scams. These people literally work to scam you and that’s how their companies get their money. That is baffling to me.
So glad all of you have been saved from financial ruin and could focus on your health
This happened to me twice where my network hospital used out of network anesthesiologists. The first time I was freaked out. It took a lot of digging and insistence on my part to get it resolved. Hospitals blame the providers, the providers blame the insurance companies, and the insurance companies blame anyone they can. The 2nd time it happened I knew the score. I made one phone call, mentioned the No Surprise Billing Act, and never heard from them again! 👍🏻
"we dont have time for all that"
"See that isnt my problem, you had the time to send me the bill clearly. You can send another one for sure."
Id report them anyway
Advice from someone who works in healthcare:
-The No Surprised Act requires hospitals and doctors to provide estimates on procedures to patients. They are also required to send a written copy to you so if you ARE surprised, you have the documentation to prove it. You shouldn’t have to request it but make sure you know your rights.
-It used to be that the place recommending the procedure was required to get an all in one estimate for the patient for their fees, hospital, and anesthesia. That was amended in 2023. Now, you as the patient have to call the individual places for those numbers. (Doctors, hospitals, and anesthesia usually have their own bills and RARELY share it with patients let alone each other.)
-To make things easier for estimates, ask the doctor and preregistration for the CPT codes associated with your procedure. There are multiple codes for MRIs, CAT scans, and more so having the exact one is IMMENSELY helpful and more accurate. (Make sure to talk to preregistration especially. I have had instances where I have received one code only to find three more added to the encounter because doctors usually do not know medical codes. That is what coders do and they know if there are affiliated codes for that procedure.)
-Also have the facility handy. Some facilities cost more than others and to be as accurate as possible, have that on hand.
-Some hospitals are able to give you an estimate for the hospital fees with your insurance details. Having those on hand is helpful as well.
-Check for Financial Assistance and Payment plan options. (Some hospital systems have both and others only do payment plans.) And when applying for charity, send your application via every method you can think of to make sure the hospital gets it. You can even ask for an application when scheduling and apply before you even have the procedure done.
-If you see anything that goes against the No Surprises Act, report it. You can threaten to make sure they get their butts in order but do not let it slide just because they corrected your bill. It will leave a history that will lead to corrective action in the future.
This is too much 😢
Another thing to remember: Don’t just ask if they “take” your insurance. Ask if the are in network. They can be out of network and take your insurance. You ARE responsible for the balance billing if you ask if they take your insurance.
Got to love our messed up health insurance system.
You are not responsible for balance billing if it falls under surprise bill coverage. Among a bunch of other situations.
A couple of years ago I had to go to the ER and the couldn't tell me if they were in network or not. You need to know before hand.
Exactly. It's not up to the doctor to decide if the insurance company will pay. It's up to the insurance company to decide if they will pay. They should be the first call you make, not the doctor's office.
@@ngf5077oh
@jljl24 good thing those days are in the past 😊
I got a bill for $700 for bloodwork. My main problem with medical billing disputes is that it is extremely difficult to even talk to anyone. They say call this number and when you do it's an automated message that says leave your name and number and we'll get back to you. But they NEVER call!
Document time, date, and disposition of every call in attempt to resolve. Let them send you to collections. When the collections company starts calling tell them verbally and in writing, that you have no business with them and to stop calling (there are attorneys that will give you great advice and forms for just this, cheap). You business is with "xyzzy Medical Co". You only talk with them. Contact your insurance company. Most importantly, keep good records. Keep up with who and what your insurance has paid out. If a lab initially charges $700 for the bloodwork you are having done, but your insurance company and lab have agreed to $200 for that lab work, that lab may likely send you a bill for the $500 that the insurance didn't't pay, but the lab agreed to the $200 with the insurance company. Most people don't even question this, they just pay it. Contact your insurance company immediately and don't pay that bill until you find out you owe that for sure. Likely it's just a bait. If you pay it, great! (most of us want to pay our bills). If you don't pay it, they may threaten collections, may even initiate collections. Don't fall for it. Check with your insurance company BEFORE you pay that bill. Likely your insurance has paid the agreed upon price. The insurance company works for you!
When that happens to me I start calling and leaving messages one right after the other and my last message says this, “ if I do not hear from you within the week I will know this bill is null and void and you have resolved this issue internally. “
Then I make notes on days and time and exactly what was said by me.
@@brendabowers2320great idea, hopefully it works.
Be careful not to sign any papers agreeing to pay OON charges.
Also, hospitals have entire billing departments designed for billing. They have so much time.
When my mom was in the hospital they handed her a piece of paper with minuscule writing on it telling her about the out of network doctor. They made it sound like if she didn't sign she wouldn't get care. You couldn't even read it it was such small font.
It may be in the fine print of the 15 page document you just read and missed it.
Can I refuse it? Im quite sure all my appointments anywhere has required me to sign something like that, or refuse me service. The document 1 paragraph just says that if insurance doesnt cover, I'm required to pay.
@@aj-sz8mubut they also aren’t allowed to deny treatment. Not sure of the full legal stuff.
Go ahead and sign, the act makes these types of "contracts" not hold up and unenforceable. Source: I had to deal with a hospital doing this to my wife and son, don't owe the out of network anymore.
I work with insurance!!!! Definitely inform the doctors to send this claim to the insurance 9/10 the insurance will inform the doctors that they will have to write off the charges, and since it's an in network facility they're contacted to do so!!!!! Always call insurance for clarity on claims processing!
Erin = 💯
Another Pro tip: if you have a choice, never get expensive imaging done at the hospital. There are freestanding radiology clinics that charge a fraction of what hospitals do for MRIs, CT scans, etc. Just tell your physician you want a printed order (yes, on paper), and take it to the radiology clinic. They will bill your insurance for a lot less, which will lower any patient portion you may owe (deductible, co-insurance).
Yeah. I got surgery done on my broken foot. And we did it at a clinic instead of a hospital b/c it was going to be much cheaper.
Always go for an ambulatory surgicenter if it’s a choice. These are licensed facilities, at a fraction of the cost of a regular hospital.
I found out too late. Astronomical bill, non negotiable. Evil bastards.
@@lb5358 - so sorry; if it ever happens again (hopefully never), contact NPR. They have a group within them that can call out and shame predatory healthcare providers- and get the bill substantially reduced. Or, contact a healthcare journalist at a major publication. Negative publicity is a powerful thing:
Gosh, Americans go through too much. In the UK, scans like that are for free...
I'm not American and every single sentence in this video disturbs me xD How can you folks live with all of this?! Must be so stressfull, I'm sorry!
It is sometimes!! ❤
We have no choice. We elect politicians who are supposed to fix it for us. It’s not like they don’t know it’s broken. Too much money involved and lobbyists.
@@cconnon1912 it just shows how starkly the US is not a democracy. Because if everyone hates it, it should be possible to change it. But it seems no one wants to, or the other option is that you don't actually live in a democracy.
I did this in 2001. I was in a hospital that was a provider with my insurance. Weeks later I get a bill. I called and they said their in house laboratory was not a provider for my insurance. I refused to pay told them I was getting a lawyer. I was also going to report them to the appropriate government agency and insurance commissioner for my state. I also told them that if they were right and I had to pay they would receive 5 dollar payments until the money was paid off. Somehow I never got another bill. 😂
Also- always always always ask for an itemized bill! The costs tend to magically go down when they have to admit to charging $100 for a bandaid in writing.
Edit: THIS IS FOR IF YOU ARE PAYING OUT OF POCKET FOR CARE. Thank you to the person who reminded me of this in the replies!
When I had my son by c-section last year, I couldn’t wait to leave that horrible hospital. The mother-baby room was disgusting, and all night long, every 2 minutes, my broken IV pump beeped because it was malfunctioning, oh, and the patient in the room next to me had Covid, so I could hear her hacking through the wall and there was a PPE / Droplet Precaution sign on her door. Yuck. I couldn’t wait to leave. I had him at 5 on Friday, and by the Sunday morning, I was ready to get out of there. I asked the doctor during morning rounds if I could leave. She told me that was fine and that she would start on my discharge paperwork. Hours went by, and I asked every nurse that came in my room, but no one knew what was taking so long. Finally, around 5 PM, I was so annoyed with still being there, and having asked so many times, that I just started packing up my stuff because I was going to just walk on out of there. and nurse finally came in and angrily handed me paperwork to sign and do you know what? When bills started coming in a couple of weeks later, I learned I had been charged for an extra day because I was there past 3pm. That was THEIR fault, against my will. 🙄
@@sayhello5377Please tell me you fought them on that
@@sayhello5377 Imagine living in one of the only western country without public healthcare, saying private is best, then constantly see those stories beibg passed around.
@@arakwarno one, not one single normal person in this country thinks that private healthcare is best. What people in government positions say is totally out of touch with what most people here actually think. We all know our healthcare system is crap! And those that advocate FOR it, are not affected by it.
@@sayhello5377and I was charged for SEVEN of those armbands! They even charged me for the ones they put on elderly people who are fall risks.
This network stuff is BS. Just legislate universal healthcare!
Oh, we should have thought of that! Clearly the first time we’re hearing about it 😅 Don’t act like you invented it.
@@Kirsten_is_cursed10What are you talking about? The comment clearly relies on the fact that we all know what that is
@@vyncentelwyn4304what? 😂 I’m in Canada and you’d be lucky to even have that option 😂
How do you solve for the fact that the effective tax rate would sky rocket for people who generally take care of themselves? Most medical services are for lifestyle choices including obesity.
That they'd even try that when they know it's illegal is so disgusting
More like incompetent.
There's also a huge disconnect in hospitals that allow outside providers to practice because they cannot speak to the contract status of those providers. The hospital system I work for only allows a couple outside surgeons to practice at one OR suite. If this happens it's on those surgeons to eat the costs for not communicating their participation status to their patient.
Otherwise, all contracts are the same for our hospitals & physicians.
Please also pay attention to paperwork you are signing before going into a procedure. They could slip in a form where you acknowledge that an “-ologist” is out of network and give consent to it by signing… and then there is no legal recourse you can take since you “signed off” on it.
It depends. If they gave you drugs before giving you the paperwork, then you weren't mentally competent to agree. Even if that's not the case, you're signing under duress, which is also illegal.
This is a step in the right direction, but if I'm forced to have healthcare, all doctors and hospitals should be covered.
While I agree for the most part, I have been sent to some sketchy doctors and would never agree to have my pet cockroach to a doctor like that. So if one gets sent to a doctor you are not comfortable with, say something. I was sent to a new arthritis doctor. Nope, no way. I went to the referring office and said nope, no way, next . . . One has to advocate for yourself. Not fun but necessary.
@@naomiemoore5725you can still choose in all cover systems
@@naomiemoore5725 Now imagine that all other doctors are « out of network ». Ylu’d be stuck with that bad doctor.
Being insured should mean being covered.
@@arakwarYes, I have dealt with that too. I rarely settle with a doctor that I can't work with. Hence searching for a new one, yet hanging on to the current one until established elsewhere so there is no gap obtaining my current medication.
Maybe at hospitals, but private practices sometimes don't even want to deal with insurance. They just take a flat rate for the year for you to see them.
Erin is out here kicking ass and taking names and saving our butts. You rock Erin. Thank you!
This information is exactly what I needed for an out of network charge for my mom recently - thank you! You are the best!!
I’m not American so this isn’t relevant to me but I really appreciate you putting this crucial info out there Erin.
I'm european and I am surprised by the cost of the anesthiology. 20.000 dollars? It's insane
@@carlac4407 me too. A friend of mine was telling me about the $10,000 bill for delivering her baby in the US (this was about 16 years ago) and I was freaking out thinking that it was a really problematic birth with heaps of complications and life saving interventions. Turns out it was just a normal birth 😮
I'm so glad I don't live in the US 😂 it sounds wild. No healthcare, horrible education, school shootings and gun lovers, racism and horrible rights for women, and people going crazy to put a criminal person on the throne another 4 years. 😬 The list keeps getting longer
American healthcare is soooo expensive it’s kind of scary
America’s health system IS dystopian
so glad that I live in a civilised country with universal healthcare.
Yea, that America subsidizes. With American tools, training, imaging tech and medicines. You're welcome
@marty8722 yea cuz there's no any tech, training, imagin tech and medicines outside the US 🤦🤦🤦 /s
@Nathan_Bookwurm only cause we sold it to you. Not just Healthcare, but military and industry funding as well. If we backed out of our trade agreements, you'd be back to offering alcohol for pain relief.
Don't bite the hand that feeds you
@marty8722 dude no. The rest of the world is doing just fine medicine wise. The USA might produce the most but it's not even close to being the most per capita. Also it's not like all medical research or advancements take place there. I mean the first heart transplant took place in South Africa. Other developed countries are usually just smaller.
Also the US has a practice of making minor tweaks to drugs to keep their patents so that they can make more money which they count statistically as "making new drugs" so that's why it looks like they produce the most. It's just a gift. New drug development is a collaborative effort between universities globally, it's not something one big company does. They just take that primary research, tweak it and then patent it. The rest of the world is doing just fine thanks. Get off your American supremacy soap box.
@@sneakylemon8513 Furthermore, the US medical industry is not working to better the health of Americans. Just think about the opioid crises which already cost thousands of lifes. This was caused by American pharmaceutical companies developing this highly addictive pain-killers and pushing doctors to describe them. That kind of US innovations we rather go without.
Providers can also rite off charges if it's out of network. I worked in insurance. Providers will often send out the full bill because ( sadly) alot of people won't challenge it and just pay to avoid the time and hassle of calling to inquire. Thank you for sharing this with consumers.
This is false. The providers don’t bill patients if the provider is an employee of the hospital, the hospital is responsible for billing/receiving money from the insurance. It’s not a provider’s job to research YOUR insurance specifics and see if they are in network or out of network for a patient-it is the hospital and patient’s job!! Jesus christ.
Write* for a former insurance worker. You sure do fly through texting huh
@@rickyguill5067 for a complete stranger, you sure are judgmental and rude about a minor spelling error.
Interesting! In 2018 my son was burning leaves and caught one hand on fire. 2nd degree burns. Rushed him to the nearest ambulance station and they took him to the closest hospital an hour away. They then referred us to the closest burn clinic which also was an hour from home.. It was via the Mercy hospitals and we used Mercy clinic all the time, but all the same I asked the clerk at check-in if our visit required pre-authorization. She assured me that they took our insurance and were in-network. When the nurse took us back, I again asked her. She assured me the same. When the Dr came in, I again asked him. He asked who my insurance was and said oh yes, no problem. About 10 months later we got a huge bill. I fought it for 18 months. The Dr even wrote a letter stating that he remembers me asking and he assured me he was in-network. My insurance company didn't care. They kept insisting I owed it. Exhausted, and worried about a tarnished credit score, I finally just paid it. 😢 The insurance told me the closest burn center near me was in Tennessee or Oklahoma (I don't remember now) but it was a 6 hour drive away! They even told me that they would have pre-authorized it IF ONLY THE BURN CENTER HAD CALLED. 😮 I kept saying Ok, and how is that MY FAULT? I'm a lay person. How am I supposed to know how to do their job? And I'm sure the clerk would agree that I asked if we need pre-authorization. Ridiculous!!!!
@@cita_m people like this live for that one letter error and the chance to exert their thought of perception of superiority. However, it is truly obvious who's the fool.
When I was preparing for my surgery at the end of November, I called my insurance company and specifically asked this question. My insurance company told me that if I did receive a full payment bill for any of the "extras" like anesthesia, pathology etc to call them because you don't get to choose those and they HAVE to cover them. They did the same thing for the ambulance company when I made a 911 call, they weren't in network but I didn't get to choose when calling 911 so they covered it anyway.
Damn u slayed
This exact thing happened to me in 2016. Emergency surgery at in-network hospital, then received statements from insurance provider which showed the anesthesiology charges were not being covered by my insurance. I started making phone calls to the hospital and insurance provider and finally got the name and phone number of the company that provided the out-of-network contract anesthesiologist for my surgery. I called them with questions about my bill (which I had not yet received), and they could not even find my name or any relevant information in their system. I made it clear to that anesthesiology company, the hospital, and my insurance provider that I had no intention of paying out-of-pocket for something that was clearly supposed to be covered in-network, especially as I was not informed before the surgery that the hospital was using an out-of-network contract anesthesiologist. I never received a bill from the anesthesiologist and never heard anything else regarding the issue from the hospital or my insurance provider.
Damn, america sounds like a dystopia
I went to an urgent care that was covered by my insurance but they had to do imaging for me that needed preauthorization that I wasn't told about until after and the CT scan/ imaging was done, the imaging was done in a different section of the building that was connected to the urgent care that was a hospital that was not covered by my insurance. Luckily, the hospital covered my bill because I qualified for low income forgiveness, but I would have been stuck with a $10,000 bill. I don't know if there is any law that hospitals or urgent cares need to tell people about this, but it's important if they want to move you or do imaging that you make sure you call and talk to your insurance company beforehand or have a loved one help you. I've been in agonizing pain on the phone with my insurance. Better yet call your insurance and figure out the hospitals closest to you that you can get in network coverage and ask your insurance what needs preauthorization, so you are ready in an emergency. Our healthcare system is awful, I'm so glad this law was passed, I have always been fearful of this and having to demand that I only get in network coverage.
When you turn 65 pay for the supplement rather then getting the Advantage plan. If you choose the Advantage plan you will have to get referrals for treatment. With the supplement you avoid referrals. Especially avoid the Advantage plans advertised on tv by old sports figures and actors, the companies they represent are infamous for denying coverage.
Advantage plans are great for those that never have health issues but terrible for those that get serious health problems.
@@jamesodell3064 I'm 29🤣, but thanks for the tip, if it still applies in 36 years.
I’m from the UK and this makes me realise how important the NHS is and how much it needs to be fixed. I cannot imagine being unwell and having to worry about insurance and asking the right questions and getting bills. I’m 36 and never been billed for anything health wise (except minimal dental charges which are also mostly NHS covered). Even our prescription medication is ‘free’ in Scotland. I know we might pay national insurance but it’s so worth it to me to not have these worries for me or my family.
So many people want a system like that but I honestly think it would be a nightmare if we tried to implement it here. Our population is so huge and our border is also wide open. Our politicians are giving credit cards to illegals ffs. They don't know how to run anything and many of us are very wary of handing the reins to them when it comes to our healthcare. We have to come up with a better system though bc this is so completely fucked.
@@JS-mg1mk Your country is rich enough to cope with your supposed problems. Immigrants are not a problem and contribute a lot to society.
@@JS-mg1mkThe weird thing is that US state and federal government spend more per capita on healthcare ($5400 per year) than the UK ($3800).
@@alwaysannoyed11 well you're clearly uneducated on that topic. We have more illegals pouring in than any country in the world and no, they are not contributing more than the average citizen. The vast majority are a drain on the system.
@@119beaker Yes I'm aware. The system is definitely broken but clearly the government doesn't know how to fix it which is why I wouldn't want them to retain complete control over it. We don't need to give them any more access to our money than they already have.
Hospitals already have a workaround: if you are going there for non-emergency services, they’ll have you sign a document that basically says that they work with multiple providers, some of which might not be in network. It will also have language saying that, while they try to do what they can, they make no guarantee nor assurance that all providers that provide their services to you will be covered in network.
One thing to understand is that very few doctors that work at hospitals these days work for the hospital; they have a contract with the hospital to work there. This leaves them open to have separate agreements with the insurance companies.
Yikes. Good to know. I wonder if they would deny care if you declined to sign that
@@monicag.1527 in non-emergency situations, quite possibly.
@@monicag.1527 I was wondering this also!
They will screw us one way or another because finding people to actually pay a bill is getting harder with inflation going crazy. No one can afford healthcare, even with insurance. Senior citizens especially.
Nevada passed a law just recently that says it's not the responsibility of the medical offices, hospitals, or insurance companies to inform you whether or not someone is in network. It is the patient responsibility to call and confirm with their insurance that a medical professional is in network. So fun.
Nevada has the best legislature that money can buy.
@jamesodell3064 right! Too bad Nevada citizens can't afford their fees.
Yeah, crazy that you have to have a modicum of responsibility to be literate on the specific insurance benefits YOU are paying one of dozens of insurance companiesTHOUSANDS of dollars per year to receive! Nitwit.
Federal law supercedes state law. This Nevada law can't negate the No Surprises Act
Wow good info, thanks!
Excellent! I just went through this! I knew not to pay the bill!!
Me too!
As someone who doesn't live in the US I have no clue wtf this is, my insurance covers me to whichever hospital I go
The healthcare/ insurance system in the US is odd and very pricey.
Im living in the Philippines, low middle class, got a job, im insured both nationally and a private one.
2015. I had an emergency surgery due to acute appendicitis. I chose a private hospital cuz i trust them better.
Anyway. I had one of these bad luck time where most of the anesthesiologists are attending a seminar and the one who anesthetize me isnt covered by my private insurance. Though it is somewhat a surprise i only had to shell out almost 200 usd to pay the anesthesiologist.
But compare 200 to 2000 or 20 000 usd? Why so much US?
Unchecked capitalism and greed. The love of money is the root of all evil, and that's what runs our country. I so wish I didn't have to worry about whether I can afford my health insurance, my medication, or the doctor visit and just go get things done.
Because we have anesthesiologists that won't inject the wrong drugs because they're paid pennies.
That's what socialized medicine produces.
@@seanhazelwood3311 😂😂😂 why would they inject wrong meds? Doctors here are rich. Huge houses and big cars.
@@creestee08 Not if they're paid by collected taxes they're not. That's kinda how it works.
Isn’t it lovely how they said “ Sorry about that” though?
When’s the last time you got an apology from ANYONE?!
I swear your doing the lords work
I totally agree, but also, if you are in the Lord, it's all for the Lord aka the Lord's work. Ecc 5:9 whatever your hand finds to do, do it with all your might ❤
Also, to see if they’re overcharging you, you can ask for an itemized bill and they are required to give it to you. It lists everything you got and had done and how much each thing costs individually.
And often when you do so, the bill will magically shrink, because they don't want you finding out that they charged you 8 bucks for a bandaid. :)
You're one of the view people giving advice that actually makes sense and is helpful! Thanks for everything!
Used to work at BCBS... Just FYI, there are no in-network anesthesiologists. They know they're necessary for surgeries and procedures and can get away with being out of network. YOU'VE BEEN WARNED
They can still surprise bill you for in-network though. I got saddled with a $3500 copay when they never told me I would have hospital costs associated with a service I received at the doctors office, they only told me about the doctor costs
That is probably from your insurance plan. I work for a hospital system and we cannot bill anything other than what the insurance tells us to bill the patient. Call your insurance and ask why they applied such a huge deductible to that one procedure.
Yeah. When I went to the er trying to figure out if my water broke, I got a bill back saying the test they did for amniotic fluid "was not approved by the FDA" and there for was not covered by my insurance. I ended up having to spend almost two months going back and forth between my insurance and the hospital demanding each bill be checked for proper coding. For the 4 total visits I had at the OBED ER, they were asking nearly $9,000 (which not to sound spoiled, but we have damn good insurance and should not have been charged more than $200 total for all 4). I stuck to my guns and made them refile everything. Now, almost 8 months later, I got notified the bills were paid in full.
If something doesn't seem right, it probably isn't. Fight for your money.
I love the videos Erin keep up the great work
As someone who has worked in medical billing, the hospital or doctor are usually very willing to talk to the insurance about a medical bill since they get paid more than if they had to negotiate a patient rate.