How is this even legal??

[vic120]

Joseph.

Thank you for the reply, but you are wrong about this. The No Surprise Act does not protect someone when the "voluntarily" go out of network. What the act does protect is OON costs when the insured did not have a choice, such as anesthsiology during an operation, or when an ambulance rushes someone to an OON provider for a true emergency.

Actually it does say there should be a good faith estimate of costs, there was none

And yes for someone to take ins card 7 times and never mention it is out of network is insane, sorry cant wrap my head around that

and in 18 years in the industry I have never heard of this happening

 

[LeeV]

Actually it does say there should be a good faith estimate of costs, there was none

And yes for someone to take ins card 7 times and never mention it is out of network is insane, sorry cant wrap my head around that

and in 18 years in the industry I have never heard of this happening

I understand your frustration, nothing I can do about that. What I can tell you is that the good faith estimate means nothing, taking the insurance card 7 times mean nothing. And in my 42 years in the business, I have seen this way too many times.

 

[vic120]

I understand your frustration, nothing I can do about that. What I can tell you is that the good faith estimate means nothing, taking the insurance card 7 times mean nothing. And in my 42 years in the business, I have seen this way too many times.

im reading this now on the Ohio site it does say emergency AND nonemergency

Seems there should be an understanding of costs prior too billing

this is supposed to be received in writing as well as a copy of rights and billing protections document

and you are not supposed to be charged more than $400 above good faith estimate

 

[LeeV]

im reading this now on the Ohio site it does say emergency AND nonemergency

Seems there should be an understanding of costs prior too billing

this is supposed to be received in writing as well as a copy of rights and billing protections document

and you are not supposed to be charged more than $400 above good faith estimate

Last time, I understand your frustration, but you are wrong. You appear to be doing a cursory reading of a complex law.

Yes, it does say emergency and non-emergency.
Yes, I agree there should be an understanding of the costs prior to billing, but it is not required. Also, since you are going to these specialists for the first time, how would they know what charges may be incurred? If I made an appointment at my PCP for a sore throat they can make an attempt, such as OV, culture, etc.
No, you are not required to receive in writing an estimate of the costs because you are insured, as per your prior posts.
No, you are not supposed to charged more than $400 above the GFE because you are insured. HHS has announced that it will defer enforcement of the GFE requirements for those covered in a health plan.

 

[Joseph Schneier]

In non-emergency situations providers are still required to provide a good faith estimate and for that to be clear to a patient. You must consent to out of network care. Additionally, if you receive out of network care at and in-network provider you cannot be balance billed unless you consented in writing. If the bill is more than $400 above the good faith estimate you can dispute it.

 

[LeeV]

In non-emergency situations providers are still required to provide a good faith estimate and for that to be clear to a patient. You must consent to out of network care. Additionally, if you receive out of network care at and in-network provider you cannot be balance billed unless you consented in writing. If the bill is more than $400 above the good faith estimate you can dispute it.

Sorry, but you are wrong. These rules do not apply to insureds.