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Surprise! New law started on 1/1 to cut thousands of dollars in medical bills

After someone is injured in a car accident, they must be treated immediately. They naturally assume their medical bills will be paid quickly — by someone else. But unfortunately, this doesn’t often happen.

We strive to get our clients the maximum in-pocket recoveries of money. We also stay on top of all new laws and court decisions that can help them.

So we are excited to announce some great news for the victims of car accidents in the Dallas-Fort Worth area.

The “No Surprises Act” took effect on January 1st.

So what does that mean and how can that help you?

What are surprise medical bills?

How do these sky-high medical bills even happen? Why haven’t they already been paid by one or more of the following sources:

(1) the at-fault driver’s liability insurance company,

(2) another responsible company or entity,

(3) your health insurance plan, or

(4) other benefits you are paying for?

The answer is complicated.

That is because weeks and even months after the collision, medical bills are mailed to the patient. The amounts for hospital and doctor visits can be enormous. But no one has tried to coordinate benefits.

Between the ambulance, hospital, emergency room, radiologists, and other specialists, medical bills can be as high as $20,000 or more, even with routine strain/sprain diagnoses.

If they are not paid, they are turned over for collection and lawsuits. The harm to someone’s credit rating and finances can be severe.

This is a serious problem. Over half of emergency room admissions lead to surprise medical bills. They are the number one reason Americans file for bankruptcy every year.

What causes the problem?

If the hospital or doctor is “in-network” with the injured person’s plan, they only have to pay a co-pay and deductible. A discounted rate has already been negotiated.

So after you pay the $100 or so co-pay, if the deductible has been met, the total bill which could be as high as $10,000 has been paid. So that can be a good deal.

But problems quickly arise.

The injured person presumably does not know whether the hospital and providers were in or out-of-network. And if they knew to go to a Texas Health Resources hospital, it may have been in-network but the separate emergency room, doctor, or x-rays may not have been.

Are there other reasons?

To add to the confusion, the at-fault driver’s liability company will make excuses and stall for as long as possible. It will not pay your medical bills up front. Ig does not want to pay them at all.

Your health insurance company may choose to contest, deny, delay, or underpay claims. It may argue that it was not properly notified, not primary, all records were not submitted, incorrect CPT codes were used, and on and on.

Or many victims don’t have health insurance in the first place and are stuck with the excessive rates.

Many medical facilities are losing so much money that they inflate their services after a car accident hoping that a liability insurance company will pay them.  Even if Blue Cross only pays one-half, they still get paid handsomely.

Further, hospitals are allowed to file liens on the settlement or verdict to secure their claims for reimbursement.

One of the best reasons to hire a good car accident lawyer is for their expertise in reducing outstanding medical bills.

The new law

The No Surprises Act of 2002 is one of the most consumer-friendly acts enacted by the United States Congress in decades.

It finally passed on December 27, 2020, but did not take effect until over a year later, which is rare.

The new law

  • applies to almost every private health insurance plan and to all Affordable Care Act policies;
  • covers almost every emergency service;
  • requires insurance companies to bill policyholders only the median rate for an in-network emergency service, even if the provider is out-of-network;
  • prohibits most balance billing;
  • sets up a binding arbitration process to resolve payment disputes; and
  • uses the federal government to help enforce state laws already in place and imposes fines up to $10,000 per violation.
Patients can still choose to see their doctors who are out-of-network, but only if they are notified in writing and given estimates.

However there are exceptions. Ground ambulances, which are usually out-of-network, are exempt. Fortunately, air ambulances are covered, as they can charge as much as $50,000.

Texas has had a more limited surprise medical bills law and mediation process for years.

We can help you fight these medical bills

If you were billed excessive amounts or have received large and unexpected medical bills after your car truck, 18-wheeler, motorcycle, or pedestrian collision, Berenson Injury Law can help you.

Further, the new law faces lawsuits filed by hospitals and doctor groups, so its final status is up in the air.

Even after the trials and appeals are finalized years from now,  you can continue to expect excessive billing and problems. So this problem is by no means resolved.

We are hopeful the law will be upheld and this horrendous problem stops.

If you have any questions, call us at (888) 801-8585 or click here.

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