What Do I Do About My Surprise Medical Bill?

Have you ever received a medical bill that you thought was being taken care of by your insurance, or received one that was far more than expected? This situation in which you receive a surprise medical bill is commonly referred to as “balance billing”.

When you seek medical care, you often choose where you go to obtain care based on in-network providers and your personal preference.  Choosing in-network care is typically the most affordable option. Unfortunately, even if you choose an in-network provider or care facility, some providers may attempt to collect funds from you – above and beyond the maximum amount payable by the Plan or any copay, coinsurance, or deductible you may owe. This is called balance billing.

Normal copays and coinsurance payments are part of an employee’s responsibility; however, participants should have the peace of mind knowing they have support when it comes to unfair billing and out-of-pocket charges. “The TSHBP guarantees that you will never have to pay for a surprise medical bill if you allow our team to assist you”, says Christina Adams, Medical Accounts Manager at TSHBP. The TSHBP has a clear goal to assist the plan members in preventing:

• Aggressive debt collector harassment.
• Potential overpayment resulting from the participant’s provider asking them to pay more than is accepted from most other patients as payment in full for the same service.
• Educate members to understand their rights and best actions to assure their financial outcome.

HOW TO HANDLE A SURPRISE MEDICAL BILL

Your TSHBP Patient Advocates are here to help you with any balance billing issues you may encounter in the following ways:

• Contacting your current providers about accepting your health plan;
• Sending letters to the provider (you will receive copies); and
• In rare occurrences, engaging in direct negotiations with your provider and/or coordinating the use of specialized legal resources.

Here are the steps to take if you receive a balance bill from a medical provider under your TSHBP medical plan:

STEP 1: Start the Process and call the Patient Advocate:

• • • Call your Patient Advocate at (888) 803-0081 as soon as you are aware of a possible issue with a bill.
      • When calling select the following options:
        • At the main menu Press 3
          • “If you are member calling for other benefits press 3”
        • At the second menu Press 2
        • “If you are calling about a balance bill you received from a provider of service press 2”
      • Send all relevant documentation to the Patient Advocate.
      • The Patient Advocate at 90 Degree Benefits will send the participant a packet of letters and authorization forms.

STEP 2: Sign and Return the Initial Letters

• • • Complete, sign, and return any letters and forms sent to you by the Patient Advocate.
    • They will retain copies for record and forward the letters on to the provider and credit bureaus stopping credit report issues before they start.

STEP 3: Staying Engaged

In the event of a bill issue the Patient Advocate will follow up with the patient or employee on a regular basis.

• • • Communication to or from the employee is handled any way the employee desires (email, fax, telephone, letter).

STEP 4: Continued Communication

If or when a second bill or notice is received, participant should contact their Patient Advocate.

• • • A second set of letters will be created and forwarded to participant. The entire process often needs more than one set of letters.
    • Participant will be asked to sign and return the new letters and forms.
    • The Patient Advocate will retain copies for record and forward the letters to the provider.
    • If the participant is repeatedly billed, there is the option to send additional dispute letters.

STEP 5: Legal Support and Professional Bill Negotiation Services

If at any point in time, the participant receives a collections notification or legal demand; our Patient Advocate will contact our expert Bill Negotiations Attorney Partner who will then assist the participant directly.

• • • The Patient Advocate can initiate settlement discussions with plan sponsored approval.
    • Our partner Patient Advocate Attorney support will assist participants in taking the appropriate actions.
    • If a decision is made to pay the balance bill, then the TSHBP will cover it at no cost to the patient.

2022 LEGISLATION UPDATE

Effective January 1, 2022, patients will be protected from certain unexpected or “surprise” medical bills under the No Surprises Act. This protects you from bills that could arise from:

1. Out-of-network emergency care (including certain ancillary services routinely available in an emergency department) provided at an out-of-network facility or at in-network facilities by out-of-network providers; and
2. Out-of-network nonemergency care provided at in-network facilities without the patient’s informed consent.

For more details about this legislation and what it means for you, visit https://www.cms.gov/nosurprises.

HOW CAN I AVOID GETTING A SURPRISE MEDICAL BILL?

While you can’t always avoid receiving a surprise medical bill, being a wise health care consumer whenever possible can help lessen the possibility that you will receive one. Of course, in an emergency and life-threatening situation, you should seek out the nearest care center.

For planned medical services, you should do your due diligence and find out what is covered before you obtain those services. Our specially trained Care Coordinators are here to aid you in finding the care you need and help protect your wallet. Contact us if you have any questions at 866.803.0081.