Tennesseans Can’t Rely On “No Surprises” In Medical Billing Due To Loopholes & Legislature Inaction
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The Tennessee Conservative [By Jason Vaughn] –
In January 2022, a federal law went into effect that aimed to prevent individuals from receiving unexpected or higher than expected medical bills.
However, loopholes in the legislation have been discovered due to an experience by a Nashville woman.
Michelle Roberts was given an estimate by Premier Radiology Pain Management Center for $230 for steroid injections for sciatic pain, but when her bill arrived it was for $908.
The first loophole is a waiver that, if signed/checked, requires patients to pay their bills, regardless of whether it’s close to the estimate.
WSMV reports that Roberts did opt to check the waiver box in the agreement for her estimate. However, the No Surprises Act allows for patients to dispute the bill if it comes out to be $400 or more above the good faith estimate.
But, the resolution process only is available to individuals who are uninsured. Since Roberts is insured, she is unable to dispute the bill. Premier Radiology Pain Management Center did, however, give her a 25% discount on the bill bringing her cost down to $681.
Braden Pan, the CEO of Resolve, a patient advocacy company, offered some tips for patients:
• Ask about cash pay. If you have a high deductible you don’t expect to fulfill, you may save money by paying cash to the office and not filing through your insurance.
• Get an itemized bill. Look to make sure they’re charging you for the services you received and there aren’t any duplicate charges.
• Call your insurance. Based on the way something may be coded, insurance may improperly deny claims. Talking with an agent and providing additional documentation may help get a claim approved.
• Apply for aid. Many hospitals have a financial aid program and you can check to see if you qualify.
In the Tennessee General Assembly, Senate Bill 0001 and House Bill 0002, sponsored by Senator Bo Watson (R-District 11) and David Hawk (R-District 5) respectively, aimed to stop insurance providers from sending unexpected medical bills to patients in Tennessee.
According to the Senate Republican Caucus, the legislation aimed to put a stop to “balanced billing.”
“Balanced billing occurs when providers bill a patient for the difference between the amount they charge and the amount that the patient’s insurance covers,” the statement says. “The amount that insurers pay providers is almost always less than the providers’ ‘retail price.’ Some providers will bill the patient for the difference or balance, thus it’s called balanced billing.”
Under the new bill, patients would no longer be responsible for those balanced bills, and providers would not be able to hunt them down to cover charges related to emergency services. Bills will also not be sent if a patient receives non-emergency care from a hospital that is “in-network” but then is treated by a doctor or laboratory that is not within their network without their knowledge.
“Under this bill, patients will pay only the deductibles and co-payment amounts that they would under the in-network terms of their insurance plans,” according to the release. “The bill also creates an independent dispute resolution process between insurers and providers.”
The bill was meant to be a replica of the federal “No Surprises Act.”
Senator Rusty Crowe (R-District 3), chair of the Senate Health and Welfare Committee, stated, “As Chair of our Senate Health and Welfare Committee, I know that one of the problems Tennesseans worry about the most, especially from a patient perspective, is the problem of being able to afford an unexpected medical bill. Sen. Watson and myself have been working on this surprise billing legislation for the past 6 years. I am very proud of this piece of legislation as it fundamentally protects patients from getting a bill for which they didn’t know they’d be responsible.”
The Tennessee bill was first filed for introduction in November of 2020, but was beset with deferrals and resets until it was finally “held on the House desk” on January 31st of this year and then taken off notice in the Senate Insurance Subcommittee of the Insurance Committee on March 15th of this year.
Whether the legislation will be pursued further in the next session of the General Assembly is unknown at this time.
About the Author: Jason Vaughn, Media Coordinator for The Tennessee Conservative ~ Jason previously worked for a legacy publishing company based in Crossville, TN in a variety of roles through his career. Most recently, he served as Deputy Director for their flagship publication. Prior, he was a freelance journalist writing articles that appeared in the Herald Citizen, the Crossville Chronicle and The Oracle among others. He graduated from Tennessee Technological University with a Bachelor’s in English-Journalism, with minors in Broadcast Journalism and History. Contact Jason at news@TennesseeConservativeNews.com
An option is to go to MDSave.com and purchase a voucher for the treatment. I did that for a CT scan and saved a few hundred.
This is a problem that needs to be fixed. I had surprise bills that arrived months after treatment. I could not compare the doctors bills with the health plans statements and sort out the mess.
First of all Why is there an estimate on any bill. These people know well in advance what things are going to cost before they tell the patient. That is the first problem. Second If you have no insurance them pay what you can like maybe $10.00 or $20.00 a month and let it go at that. These places are just gouging folks for money.
I forgot also they are doing this to people that do not have insurance because they can send in any amount they want to insurance companies and they will get paid a better amount by the insurance company even though it will not be the total amount sent in.