Imagine being denied by your insurance company and having to go through surgery. It’s a story that’s all-too-familiar for some, but a new law prevents it from happening.
Julie Randall is now feeling great, but it was not the same story last December. Randall was suffering from severe stomach pains and went to the emergency department.
“This was soul crushing pain,”She spoke. “The pain got so intense, the doctor ordered a CT scan.”
Randall required surgery to remove her gallbladder. The surgery went well until Randall was sent a bill for $86,000. United Healthcare, her insurance company denied the claim.
“Just devastated, just devastated, with really nowhere to turn,”Randall said.
These are the words of the industry “surprise bills.” Patients typically get them after hospital stays, when they assume the doctors treating them are in network, but they later learn they aren’t, so they’re on the hook for that part of the bill.
The non-profit group Kaiser Family FoundationEach year, patients receive 10 million surprise bills in their mailboxes. A new federal law has put an end to these surprises. It went into effect on Jan. 1, 2022 and states that insurance companies must pay out of network bills for emergency rooms and non-emergency services at in-network hospitals. This includes doctor bills such as anesthesiologists. The law also prohibits doctors and facilities from billing patients for what the insurer doesn’t pay; the patient is only responsible for their standard in-network co-pay.
“This is a new thing for the federal government, to actually reach inside a plan and regulate how claims are paid. They don’t usually do that,”Karen Pollitz from the Kaiser Family Foundation.
Under the new law, if hospitals and doctors bill you beyond what you’re allowed, they can be fined $10,000.
Some exceptions to this law exist. If you schedule a non-emergency surgery in advance and hand-pick a specific doctor who’s out of network, you’re agreeing to pay that doctor’s price. Ambulance bills aren’t covered either.
Randall’s surgery happened two weeks before this law took effect, so the I-Team reached out to United Healthcare about it. It cleared Randall’s bill, nearly $90,000, saying the bill had actually been “processed incorrectly,”Despite her appeals. It also said that “strongly supports efforts to protect people from surprise medical bills.”
Randall was contacted by the I-Team with the good news.
“I felt like the horse that won the Kentucky Derby,”She spoke. “No likelihood of ever winning, entering the race at the last minute, longest shot on the board. I didn’t have any inclination that reaching out to NBC would have resulted in the way it has.”
Find out more information about the new law Here.