Arztrechnungen überraschen

"Surprise medical bills" are when you get an unexpected bill from an out-of-network provider for an amount that exceeds the patient's cost-sharing obligation that would have applied had the services been provided by an in-network provider. The Surprise Billing Act protects patients from unexpected billing costs. This means that you may receive separate bills for your out-of-network provider. 

When patients receive emergency care or are treated by an out-of-network provider at an in-network hospital, they are protected from surprise billing. Patients shouldn’t be charged more than the insurance plan’s in-network copayments, coinsurance and/or deductible.

Was sind überraschende Arztrechnungen?

A surprise medical bill is when an out-of-network provider bills a patient for the difference between the charges the provider billed, and the amount paid by the consumer’s health plan. This is known as balance billing. When a patient receives a bill for the difference, it is an unexpected balance bill or a surprise bill. If a patient knowingly chooses to receive services from a nonparticipating provider, balance billing is allowed for non-emergency care.

Das „No Surprises Act“ von 2022

Das No Surprises Act schützt Patienten, die im Rahmen von Gruppen- und Einzelkrankenversicherungen versichert sind, davor, überraschende Arztrechnungen für die meisten Leistungen zu erhalten. Dazu gehören Notfall- und Nicht-Notfalldienste von Anbietern außerhalb des Netzwerks, die in Einrichtungen innerhalb des Netzwerks arbeiten.

Das No Surprises Act sieht auch ein Streitbeilegungsverfahren für Zahlungsstreitigkeiten zwischen Plänen und Anbietern vor und bietet nicht versicherten und selbstzahlenden Personen die Möglichkeit, Rechnungen anzufechten, die höher sind als die Schätzung nach Treu und Glauben, die sie vom Anbieter erhalten.

Was ist eine Schätzung des guten Glaubens?

Health care providers are required to give scheduled uninsured or self-pay patients an estimate of the bill for medical items or services.

Prior to a scheduled service, patients have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services. This also includes costs such as medical tests, prescription drugs, equipment and hospital fees. Patients should request a Good Faith Estimate in writing at least 1 business day before the medical service or while scheduling.

Wenn ein Patient eine Rechnung erhält, die 400 $ oder mehr beträgt als die Schätzung nach Treu und Glauben, kann die Rechnung angefochten werden.

Was ist vor Surprise Billing geschützt?

If you receive emergency care out-of-network, you may only be responsible for paying what you would owe in-network, such as co-payments or deductibles. Your care can continue until you have been stabilized. Providers cannot bill your services until you have been stabilized.

Andere Dienstleistungen?

UNM Health kann helfen

If a patient believes they have been wrongly billed, they may contact a UNM Health Patient Financial Services Specialist at the following locations.