If you live in Oklahoma City, Oklahoma, and you have health insurance, you may have experienced a “surprise” medical bill at some point. A surprise medical bill is an unexpected charge from an out-of-network provider or facility that you did not choose or know about in advance. The good news is that starting in 2022, there are new federal protections that prevent surprise medical bills for most emergency and some non-emergency services, regardless of whether you have a group health plan, Health Insurance Marketplace plan or an individual health insurance plan.
An example
For example, you may have gone to an in-network hospital for emergency care, but received services from an out-of-network doctor, anesthesiologist or radiologist who works there. Or, you may have scheduled a surgery at an in-network facility, but found out later that the lab tests, imaging or other services were performed by out-of-network providers.
No more surprise billing
The prohibition on surprise medical billing was part of the No Surprises Act, which was enacted on December 27, 2020, as part of the Consolidated Appropriations Act of 2021. Now, you cannot be charged more than in-network cost-sharing (like coinsurance or copayments) for emergency services, even if you get them from an out-of-network provider or facility and without prior authorization.
In-network cost limits
You cannot be charged more than in-network cost-sharing for non-emergency services from out-of-network providers at in-network facilities, unless you receive a notice and consent to waive the billing protections at least 72 hours before the service. This does not apply to certain additional services (like anesthesiology or radiology) that are furnished by out-of-network providers as part of your visit to an in-network facility.
What are my options?
If you live in Oklahoma City, Oklahoma, and you receive a surprise medical bill from a health care provider or facility after January 1, 2022, you have options. Check your advanced explanation of benefits and compare it with your bill. Make sure that you are not being charged more than in-network cost-sharing for any services. If you believe that you have been billed in violation of the No Surprises Act, contact the provider or facility and ask them to correct the bill. You can also file a complaint with the Oklahoma Insurance Department or the U.S. Department of Health and Human Services.
If you are not satisfied with the response from the provider, or if you disagree with what your health plan paid, you can request an independent dispute resolution process through your health plan or the provider. You will need to provide evidence to support your claim, such as your advanced explanation of benefits, your bill, etc.