Hey everybody. It is Matt from Situation Positive. And I want to talk to you about something that we all worry about, and that’s a surprise bill from a medical encounter. Now, why might you receive a surprise bill? Let’s say you go to a big physician practice. And your doctor is in-network, but they’re unable to see you today.
So you get seen by a provider that you’ve never met before that provider’s not contracted with your insurance. So they are out of network and you end up receiving a surprise bill in the mail for a medical encounter that you thought was covered. That happened all the time. They just passed some legislation called the no surprises act, which aims to eliminate that billing practice and shine a light on transparency for that kind of out-of-network encounters that as a patient, you have no idea.
You just think that everybody at the facility would be covered because you’re allowed to go there. And let me tell you a personal story about this because I actually went through this myself. So my second son was being born. My wife was about eight months pregnant when we moved from Boston to Arizona.
And I had already been diagnosed with MS. I was on, you know, a treatment that required prior authorization. So I was starting to learn about the ins and outs of the patient journey. Some of the things that I needed to do. So one of the smartest decisions I ever made was when I was moving, I knew we were scheduling a C-section.
So I called insurance and I found the hospital that was in-network in Arizona I called the doctors to make sure we had the right doctors that were in-network. We scheduled the C-section and prior to that C-section, we were in prior authorization. We signed off on everybody that was supposed to be in that room and that they were covered by insurance.
So come, come August 12th, 2009. We’re excited! It’s going to be a morning birth. Like I can’t sleep the night before cause I’m about to meet my new son and we get to the hospital and it’s flawless. Well for me, but you know my wife might have a different story, but I mean, I get to meet this beautiful baby boy, and we’re just so much in love everything’s going great.
Everybody at the hospital was wonderful. Fast forward a couple of months later, I get a $6,000 bill in the mail because the anesthesiologist was not in-network. And I went and I looked up the anesthesiologist’s name and I looked at who prior authorization said, was said, was going to be our anesthesiologists and the names were different.
So I called the provider’s office and they said, well, this is the provider. This is the anesthesiologist that your doctor likes to use. And so, you know what I did, I didn’t panic. What I did was file an appeal. I went through insurance. And I went back through the steps through all the prior authorization steps through the list of providers that we had authorized and to the fact that on the day of the birth, no one communicated to us this change.
So it ended up being the doctor, making that change without us being aware. And we won that appeal. We were not responsible for that $6,000. And let me tell you that was a game-changer, right? Cause we had just moved across the country. We were still getting established. I don’t even think I had a job yet.
So we would not have been able to afford that extra bill. You know, we were just getting by as it was. But it was some quick thinking and knowing the system, which saved us $6,000. And won us that appeal. Now, most of you might not even know that you can appeal a medical bill. It says it in small print, usually in the upper right-hand corner of any bill, it will have a 1-800 number to the billing department and you should have some instructions on how to appeal.
If you don’t feel you need to pay for the charge, let’s fast forward to today’s landscape because that no surprises act that was just passed in the legislature protects you from that kind of billing practice. Okay. Now here’s what I want you to do. Go to situationpositive.org, click on the community tab, register for our community, and go check out our knowledge vault in the knowledge vault.
There is everything you need. To know about no surprise billing or the no surprises act. We have all the forms. If you need to make an appeal it gives you all that information. You can download it as always, you know, we’re, we’re patients, helping patients, you know, everything in the Situation Positive community is a free resource for our members, you know.
We are in this because we’ve been through it and we want to help you from going through some of the things that we’ve experienced. So this was just enacted in 2022. So if maybe you had a procedure in January and you just got this huge bill in the mail, and you’re worried about paying it, go to situationpositive.org, join our community.
Click on our knowledge vault, you’ll get all the no surprise act resources you need to be able to appeal that bill just like I did, and not having to pay $6,000, made all the difference. And I don’t want you stressed out or worried about a medical bill. You know, you’re already going through a lot. If we can help you overcome that stress and anxiety, you can focus on what you truly need to and that’s getting well.
My name’s Matt I’m with situation positive and remember, no matter your situation, you can turn it positive.
Podcast: Play in new window | Download (Duration: 7:43 — 14.1MB)
