No Surprises Act aims to reduce unexpected medical and surgical bills

While it isn’t possible to prevent all of life’s surprises, Michiganders attempted to eliminate one in health care with its own version of the No Surprises Act. But what does that mean for residents?

When visiting, say, a hospital, patients will probably see multiple providers—each one participating with a variety of plans, even if the hospital is touted as in-network with its own plan. Luckily, if they are in the hospital for nonemergent care, they probably did their homework beforehand. Is this hospital in-network? Is there coinsurance for this? They can walk in confidently, get the care they need, and have a ballpark for the cost.

But one step outside that plan could throw a wrench in the whole thing. It is entirely possible that a provider might work in a hospital but not participate in the insured’s network: Maybe the surgeon is in-network, but the anesthesiologist isn’t. This causes the bill for that service to rise dramatically, as there’s no agreed-upon price between the carrier and provider. The patient is now being balanced billed and stuck with forking over the difference between the carrier’s reimbursement and the provider’s price. Surprise!

The No Surprises Act at both the federal and state level helps to prevent this, and knowing the details can save big money. Providers are no longer permitted to bill Michiganders out-of-network prices for emergency services in an in-network facility and instead must try to bill the in-network insurer first. It also prevents that out-of-network price hike if the choice to stay in-network wasn’t made available to the consumer for whatever reason.

If this situation presents itself, providers must tell the patient this is going on behind the scenes, what a good faith estimate will be for the service, and that patients will be responsible for the difference—or potentially even the whole cost. If they don’t, carriers must pay the in-network price to the patient’s provider. These rules apply in the Great Lakes state to all health insurance policies regulated by DIFS.

How can consumers use this to their advantage? First, remind them that any provided care where options aren’t on the table, such as an emergency, cannot be billed out of network. So if they wake up from in-network surgery and get an out-of-network bill from the anesthesiologist with no warning, they have the right to the in-network price.

Ensure consumers know their plan’s network and what will happen if they receive care outside that network. Do they have a new deductible to hit? Are they completely responsible for the costs?

If their provider asks them to sign a disclosure, make sure they understand this might hike their bill. Advise them to ask questions about the availability of other options before putting ink to paper, and if no options are available, ask for the good faith estimate.

If all else fails, check the bill after all is said and done. Assure all charges are in-network. If no disclosure was signed, the in-network price should be honored for those out-of-network charges.

While Michigan’s Surprise Billing Law can’t eliminate all of life’s surprises, it attempts to take a few out of the healthcare world. Out-of-network prices can still find their way into a consumer’s total, but there are more options in Michigan to prevent that from happening before buyer’s remorse has a chance to rear its ugly head.