By Shannon Massena, Director of Human Resources
Surprise Billing is when a patient goes to an in-network facility and later receives an additional bill for out-of-network services which are generally very high. Hence the term, Surprise Billing.
For example, I know several people, including myself, who schedule a simple out patient procedure with an in-network facility, an in-network surgeon, and will request that the anesthesiologist be in-network. They confirm once again in person, and still receive a big surprise. One case includes a $1500.00 surprise bill for their "covered" anesthesiologist for an hour long foot surgery.
In this case HR was able to get the insurance advocate to argue it down close to the in-network cost; however, the patient was still left with an excessive deductible, since there was a separate deductible for in network versus out of network.
Why should employers help their employees learn about Surprise Billing?
- To help avoid an employee hurting from financial stress.
- To keep employees happy and the morale high.
- To avoid negativity toward their benefits, due to lack of knowledge, which can spread through the organization.
- In many cases, this can have a direct affect on the productivity of company.
With our tight talent market, most employers are hyper focused on retention. Helping employees truly understand their benefits as well as helping them avoid pitfalls is going to be highly appreciated. They will know you really care about them. Ask your Broker if they will provide a health/claims advocate service. Many brokers will do this for you depending on your group size.
Be aware of Surprise Billing and check out these tips below.
Arizona has issued a new law that went into affect January of this year. Here is a link to SB1441 https://www.azleg.gov/legtext/53leg/1r/bills/sb1441p.pdf.
Become familiar with it and do not sign away your rights. The days of trying your best to make sure everyone is in network and then receiving a large balance billed invoice for out of network rates on the anesthesiologist or radiologists could be gone, so know your rights. No more big surprises! Here is the AZ insurance dispute resolution help link. https://insurance.az.gov/soonbdr
Those in California had similar coverage since July 2017. See this link for the details. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB72
However, recently there have been people taken by ambulance to Zuckerberg San Francisco Hospital which turns out was an emergency room who did not serve those who have private insurance. Therefore, people still had surprise bills. California is now working on new legislation to fix this issue. Use this link to follow the new bill. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200AB1611
You may want to avoid that hospital if you are in the right state of mind to know where the ambulance is taking you, at least until a new state law is passed.
For those in Colorado there is currently a regulation that if you have DOI on your card you are supposed to be held harmless when going to a out of network facility, patients are to be charged in network rates only. However, there is no law saying the provider cannot bill you; therefore the billings continue and many people pay them. There is currently a pending legislation to fix that oversight. Keep an eye on the bill here. https://leg.colorado.gov/bills/hb19-1174
For those in Washington there is something similar that has passed the house and senate. It is currently on the governor's desk for signature. Here is the link to the actual bill https://app.leg.wa.gov/billsummary?BillNumber=1065&Year=2019&Initiative=false
DISCLAIMER – Due to the daily changing environment and guidelines being provided by the government, this information could be outdated. Please contact our office for the latest updates and guidelines. Optima Office is not responsible for any actions taken due to the information provided. The information provided here is for instructional purposes and does not represent legal advice being given by Optima Office.