health care costs

Federal Ban on Surprise Medical Bills Included in $900B Stimulus Bill

NBC 7 Responds looked at the new protections for patients.

NBC Universal, Inc.

Medical bills can quickly add up, especially when you're being hit with a surprise medical bill.

Usually, this happens when you are taken to an out-of-network facility or a doctor arrives to help treat you. The $900 billion coronavirus stimulus bill would ban these surprise bills.

"The pandemic exposed the soft underbelly of the U.S. health care system," said Niall Brennan of the Healthcare Cost Institute. "There are always edge cases and unfortunate folks who get caught between two stones who end up being exposed to financial damage."

Some people have gone in for treatment or testing, only to get a large bill in the mail a few weeks later. One of them was Melissa Chalmers.

"I had a fever, I couldn't breath, my chest hurt, I was coughing," said Chalmers about her symptoms when she went in for a COVID-19 test at the start of the pandemic. "I felt miserable."

A bill showed up a few weeks later and because she tested negative, she was on the hook for the charges.

"My concern is the lack of visibility into if you're going to have to pay," said Chalmers.

The new bill would prevent you from being surprised by large charges because part of your treatment was out-of-network. California is one of several states that already have comprehensive bans on surprise medical bills in place.

The California Department of Managed Health Care has several examples of how the state ban protects patients. These include getting tests done at an in-network facility, but the doctor who reads the results is not in their health plan. Before the ban, you would've been charged directly, without knowing beforehand.

The state law also protects consumers who are taken to out-of-network facilities for emergency care. You now will only have to pay in-network cost sharing.

The federal version is very similar, but will expand protections in the state of California. Some health plans are exempted from the current state law because they fall under federal jurisdiction.

NBC 7 Responds reached out to the state of California. They say they are still reviewing the language of the federal ban to see what the exact differences are.

If you have questions or concerns about a surprise medical bill reach out to the state DMHC Help Center.

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