QUESTION

My provider is asking me to give up my surprise billing protections in order to receive treatment. What should I do?

Post enrollment issues | Individual Health Insurance Employer-Sponsored Coverage
ANSWER

Under a new federal law that goes into effect in 2022, you are protected from paying more than in-network cost sharing in emergency care situations and at in-network facilities regardless of whether the treating provider is in-network. In rare cases, patients may choose to get non-emergency care from a provider outside of their provider network. In such a circumstance, you may waive your protections under the new federal law in order to be treated by the out-of-network provider you have selected. However, you cannot be asked to waive protections for certain ancillary services (including anesthesiology, services related to emergency medicine, neonatology, pathology, and radiology; care provided by assistant surgeons, hospitalists, and intensivists; and diagnostic services such as lab services); when care is urgent or unforeseen; and where there is no in-network provider available.

If you receive a form to sign that asks you to waive these protections, and you do not want to consent to paying out-of-network cost sharing, contact your plan and find out if an in-network provider is available. Note that the out-of-network provider asking you to waive your protections under the law and agree to be billed for the balance that the insurer will not cover must give you a notice and consent form at least 72 hours in advance of your scheduled appointment (or at least 3 hours in advance of your appointment if it’s scheduled to occur in less than 72 hours). The notice must include an estimate of the cost to obtain care from the out-of-network provider and give you notice of your right to revoke your consent at any point prior to the procedure. If you believe you were coerced into signing away your protections, you can request an internal appeal and external review from your insurer or health plan and file a complaint with your state department of insurance. If you believe a provider is impermissibly asking you to waive your rights or refusing you treatment, reach out to your state department of insurance.

To learn more about federal protections against surprise medical bills, visit https://www.cms.gov/nosurprises.

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