LANSING, Mich. (WLNS) — Surprise medical bills aren’t the most pleasant kind of surprise.
But did you know that there’s a law that protects your wallet and you from paying an unexpected medical bill?
Back in 2020, a law was passed requiring healthcare providers to inform consumers of the possibility of balance billing via a disclosure form sent at least 14 days before a scheduled medical service.
The form must explain that the consumer’s insurance company may not cover all services and that the patient would be personally responsible for any uncovered costs.
As part of the notice, patients must also be given a good faith estimate of the total cost of the care they will receive, enabling them to budget for these expenses in advance or choose alternative care to meet their needs.
The Michigan Department of Insurance and Financial Services (DIFS) recently released a guide for Michiganders to get better educated on their rights and protections from getting a bill.
But first, let’s break down what surprise bills are.
Surprise billing, also known as balance billing, typically occurs when a medical provider was not in-network and one’s health insurer would not cover the health care services at the agreed in-network rate.
“Unexpected medical bills can be a shock to people, especially when they are trying to recover from illness or injury,” said DIFS Director Anita Fox.
Here are the following tips from DIFS that will better equip you for any balance billing that comes your way:
- Review your health insurance policy.
- Know whether your policy has a network of providers and what your out-of-network benefits are, including the applicable deductible, copay, or coinsurance.
- Talk to your medical provider.
- Ask your provider if they participate in your health insurer’s network and whether the facility where the health care service will be performed participates in your health insurer’s network. You may also ask for information regarding your provider’s billing practices, such as whether they send a bill to the patient or the patient’s health insurer.
- Talk to your health insurer.
- You have the right to request that a covered healthcare service is provided by a medical provider who participates in your health insurer’s network and to contact your insurer to make arrangements and receive information regarding in-network providers and services.
- Review all documents given to you by your medical provider.
- If your medical provider is out-of-network, they are required to provide you notice that a health insurer may or may not provide coverage for your non-emergency health care service. They must also give you a good-faith estimate of the cost of the service. If you sign this disclosure, and otherwise had the ability and opportunity to choose an in-network provider, you may be waiving your surprise billing protections applicable to non-emergency health care services. If the surprise billing protections are waived, the out-of-network provider is generally allowed to balance bill you for the charges that the health insurer did not pay.
- Review your bill and your health insurer’s Explanation of Benefits.
- Review any medical bill you receive and any information provided in your health insurer’s Explanation of Benefits.