Surprise-Billing Law Loophole: When ‘Out of Network’ Doesn’t Quite Mean Out of Network
Billing experts and lawmakers are playing catch-up as providers find ways to get around new surprise-billing laws, leaving patients like Danielle Laskey of Washington state with big bills for emergency care.
A Baby Spent 36 Days in an In-Network NICU. Why Did the Hospital Next Door Send a Bill?
A baby spent more than a month in a Chicago NICU. A big bill revealed she was treated by out-of-network doctors from the children’s hospital next door. Her parents were charged despite a state law protecting patients from such out-of-network billing — and sent to collections when they didn’t pay up.
New California Law Offers Fresh Protection From Steep Ambulance Bills
The law, which takes effect Jan. 1, prohibits out-of-network ground ambulance operators from billing patients more than they would pay for in-network rides. It also caps how much the uninsured must pay.
An Arm and a Leg: How a Surprise Bill Can Hitch a Ride to the Hospital
The No Surprises Act has helped rein in out-of-network medical bills, but ground ambulances are a costly exception. Hear why this service can still hit patients with big bills and what to do if you get one.
An Anesthesiology Practice’s Busy Day in Court Collecting on Surprise Bills
Legislative crackdowns on out-of-network bills haven’t kept specialists from hitting patients with unexpected charges running into thousands of dollars.
Patients Get Stranded Out of Network as Insurer-Hospital Contract Talks Fall Apart
As hospital systems and insurers adjust to the pandemic, their contract negotiations grow increasingly fraught. Contracts for in-network care are ending without a new deal, leaving patients suddenly with out-of-network bills or scrambling to find new in-network providers.
‘An Arm and a Leg’: Know Your ‘No Surprises’ Rights
The No Surprises Act protects patients from surprise out-of-network bills. But there are caveats. For instance, these protections apply only to care in a hospital. This episode breaks it all down.
A Covid Test Costing More Than a Tesla? It Happened in Texas.
A patient from Dallas got a PCR test in a free-standing suburban emergency room. The out-of-network charge: $54,000.
Congressional Doctors Lead Bipartisan Revolt Over Policy on Surprise Medical Bills
Congress last year shielded consumers from unexpected out-of-network charges, but hospitals and doctors have decried the arbitration plan put forward by the Biden administration for negotiating these bills as favoring insurers. More than 150 members of the House agree.
At Urgent Care, He Got 5 Stitches and a Big Surprise: A Plastic Surgeon’s Bill for $1,040
The Biden administration is weighing how to treat urgent care clinics as part of broad regulations banning surprise, out-of-network medical bills. At the heart of the matter: What counts as an emergency?
Expectant Mom Needed $15,000 Overnight to Save Her Twins
Doctors rushed a pregnant woman to a surgeon who charged thousands upfront just to see her. The case reveals a gap in medical billing protections for those with rare, specialized conditions.
The Big Squeeze: More Enrollees and Smaller Networks Plague Some ACA Plans
Despite record enrollment in health insurance plans under the Affordable Care Act, some consumers who bought coverage and agents who helped them do so have had a tough start to the new year: Many say it’s hard to find an in-network doctor or hospital.
Lose Weight, Gain Huge Debt: NY Provider Has Sued More Than 300 Patients Who Had Bariatric Surgery
The private equity-backed practice has been known to demand more than $100,000 in charges or penalties. One patient is fighting back.
Olympic Dream Dashed After Bike Crash and Nightmare Medical Bill Over $200K
A bicyclist from California competed in a Pennsylvania race that could have landed him in this month’s Tokyo Olympics. Instead, a crash on the velodrome track landed him in two hospitals where his out-of-state, out-of-network surgeries garnered huge bills.
Biden’s Blanket Statement — ‘No More Surprise Billing’ — Doesn’t Quite Cover It
The president used broad language to say that Americans no longer needed to worry about surprise bills, but there are exceptions to the new law that could cost unsuspecting consumers.
How to Avoid Surprise Bills — And the Pitfalls in the New Law
The No Surprises Act offers protection from many surprise medical bills — but that protection may be only as good as a patient’s knowledge of the law and ability to make sure it’s enforced. Here’s what you need to know.
Even When IVF Is Covered by Insurance, High Bills and Hassles Abound
Only 15 states require insurance to cover in vitro fertilization, a common path to parenthood for people who have trouble getting pregnant. And even for those whose insurance covers IVF, the expensive procedures and required drugs can lead to unexpected bills.
California Expands Paid Sick Days and Boosts Health Worker Wages
Gov. Gavin Newsom signed legislation expanding paid sick leave to five days, extending bereavement leave to miscarriages and failed adoptions, and approving an eventual $25-an-hour health care minimum wage. Still, in a possible sign of national ambitions, the Democrat vetoed free condoms in schools and refused to decriminalize psychedelic mushrooms.
What the Federal ‘No Surprises Act’ Means in California
The new federal law will provide protection against surprise medical bills for between 6 million and 7 million Californians who are not covered under state law.
Readers and Tweeters Are Horrified by Harm Tied to Dental Device
KHN gives readers a chance to comment on a recent batch of stories.