Originally published by William K. Berenson.
Accident victims got some unexpected good news yesterday. A sweeping new law that will prevent most surprise medical bills was approved by the House of Representatives and Senate as part of pandemic-related legislation. The bill now moves to the President for approval where it is expected to be signed into law. Bravo!
This has been a serious problem for many years. One of the biggest problems injured victims face comes weeks or even months later when they open their mail and see enormous these surprise medical bills. They may have been treated by a hospital or doctor outside of their health insurance network and their company paid little, if any, money.
Of course, rarely if ever do people in emergency situations like car wrecks have the ability to consult their policies and know which providers will be paid.
This has resulted in an abusive practice called balance billing.
And the victims had no idea that the emergency room could charge any amount of money that it wanted to. We often see hospital bills exceeding ten thousand dollars due to treatment by multiple physicians and extensive diagnostic testing including x-rays, computed tomography, not to mention the huge costs for surgeries.
If the bills are in-network, there is generally no balance due other that the co-pay and deductible.
And adding to the financial stress, often someone has a health insurance plan but it claims that it is secondary and refuses to pay, or it eventually pays after a long delay, but then demands to be repaid in a surprise process called subrogation.
To make matters worse, the at-fault driver’s liability company has no legal duty to pay the plaintiff’s medical bills up front, so it doesn’t pay until it knows what all of the damages the injured victim has suffered and how much money they are demanding for compensation.
Surprise medical bills are a huge problem, especially in Texas where they are generated at two times the national average.
The new law took two years to be negotiated. It will help hundreds of thousands of Americans every year.
Unfortunately, it does not take effect until January 1, 2022.
The bills for out-of-network services will now be based on what would be charged if the facility or professional were in-network. There will be a dispute resolution process to resolve disputes.
Further, patients must be given estimates of the charges by out-of-network providers 72 hours in advance and be allowed to refuse to receive that care. But that places the injured person in a bind if he wants to use a certain specialist.
Everyone, including health insurance company officials, hospitals, doctors, attorneys, and the U.S. Congress, have known for many years that surprise medical bills were abusive. But they are mailed out almost 90% of the time in some Texas cities.
This has resulted in endless collection notices, lawsuits, bankruptcies, and financial hardship.
It took over years for representatives of both parties to reach this compromise.
Unfortunately, ground ambulances, which can have the highest billing rates for any out-of-network facility, are exempt from the new guidelines. At least air ambulances will be governed by the new law. Their bills can exceed $50,o00.00, so this is more welcome news.
Texas already banned some surprise medical bills
Texas surprisingly adopted one of the strongest anti-surprise medical bills laws in the country last year. SB 1242 created an arbitration process that forced the parties to resolve their disputes. However, it had a glaring exception which allowed the highly-priced out-of-network providers to force patients to agree to their bills.
Our state has had a medical dispute process for over ten years. However, it was so popular that the system was overwhelmed. Medical bills medication requests stun Texas officials
We know how horrible being in a car or truck collision is, and the last thing you need is to have to be an outrageous medical bill later. A personal injury lawyer will attempt to cut down your medical bills.
Here is more information on this topic: Best ways to reduce huge medical bills
Please contact us if you have any questions.
Curated by Texas Bar Today. Follow us on Twitter @texasbartoday.
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