Surprise-Billing Law Loophole: When ‘Out of Network’ Doesn’t Quite Mean Out of Network
By Harris Meyer
February 28, 2023
KFF Health News Original
Billing experts and lawmakers are playing catch-up as providers find ways to get around new surprise-billing laws, leaving patients like Danielle Laskey of Washington state with big bills for emergency care.
A Mom’s $97,000 Question: How Was Her Baby’s Air-Ambulance Ride Not Medically Necessary?
By Molly Castle Work
March 25, 2024
KFF Health News Original
There are legal safeguards to protect patients from big bills like out-of-network air-ambulance rides. But insurers may not pay if they decide the ride wasn’t medically necessary.
A Baby Spent 36 Days in an In-Network NICU. Why Did the Hospital Next Door Send a Bill?
By Harris Meyer
January 30, 2023
KFF Health News Original
A baby spent more than a month in a Chicago NICU. A big bill revealed she was treated by out-of-network doctors from the children’s hospital next door. Her parents were charged despite a state law protecting patients from such out-of-network billing — and sent to collections when they didn’t pay up.
New California Law Offers Fresh Protection From Steep Ambulance Bills
By Bernard J. Wolfson
November 7, 2023
KFF Health News Original
The law, which takes effect Jan. 1, prohibits out-of-network ground ambulance operators from billing patients more than they would pay for in-network rides. It also caps how much the uninsured must pay.
An Arm and a Leg: How a Surprise Bill Can Hitch a Ride to the Hospital
By Dan Weissmann
August 16, 2023
Podcast
The No Surprises Act has helped rein in out-of-network medical bills, but ground ambulances are a costly exception. Hear why this service can still hit patients with big bills and what to do if you get one.
The No Surprises Act Comes With Some Surprises
By Elisabeth Rosenthal
February 14, 2024
KFF Health News Original
The No Surprises Act, the landmark law intended to protect patients from surprise out-of-network medical bills, has come with, well, some surprises. A little more than two years after it took effect, there’s good and bad news about how it’s working. First, it’s important to note that the law has successfully protected millions of patients […]
‘An Arm and a Leg’: Know Your ‘No Surprises’ Rights
By Dan Weissmann
February 2, 2022
KFF Health News Original
The No Surprises Act protects patients from surprise out-of-network bills. But there are caveats. For instance, these protections apply only to care in a hospital. This episode breaks it all down.
When a Quick Telehealth Visit Yields Multiple Surprises Beyond a Big Bill
By Darius Tahir
December 19, 2023
KFF Health News Original
For the patient, it was a quick and inexpensive virtual appointment. Why it cost 10 times what she expected became a mystery.
An Anesthesiology Practice’s Busy Day in Court Collecting on Surprise Bills
By Jay Hancock
December 23, 2021
KFF Health News Original
Legislative crackdowns on out-of-network bills haven’t kept specialists from hitting patients with unexpected charges running into thousands of dollars.
Patients Get Stranded Out of Network as Insurer-Hospital Contract Talks Fall Apart
By Andy Miller
November 17, 2021
KFF Health News Original
As hospital systems and insurers adjust to the pandemic, their contract negotiations grow increasingly fraught. Contracts for in-network care are ending without a new deal, leaving patients suddenly with out-of-network bills or scrambling to find new in-network providers.
A Covid Test Costing More Than a Tesla? It Happened in Texas.
By Aneri Pattani
September 30, 2021
KFF Health News Original
A patient from Dallas got a PCR test in a free-standing suburban emergency room. The out-of-network charge: $54,000.
Emergency Physicians Decry Surprise Air-Ambulance Bills
By Molly Castle Work
March 27, 2024
KFF Health News Original
Emergency room doctors say insurers are increasingly declining to cover costly air-ambulance rides for critically ill patients, claiming they aren’t medically necessary. And the National Association of EMS Physicians says the No Surprises Act, enacted in 2022, is partly to blame. The law protects patients from many out-of-network medical bills by requiring insurers and providers […]
Expectant Mom Needed $15,000 Overnight to Save Her Twins
By Renuka Rayasam
April 27, 2023
KFF Health News Original
Doctors rushed a pregnant woman to a surgeon who charged thousands upfront just to see her. The case reveals a gap in medical billing protections for those with rare, specialized conditions.
Readers Call on Congress to Bolster Medicare and Fix Loopholes in Health Policy
February 29, 2024
KFF Health News Original
KFF Health News gives readers a chance to comment on a recent batch of stories.
How Your In-Network Health Coverage Can Vanish Before You Know It
By Elisabeth Rosenthal
March 15, 2024
KFF Health News Original
One of the most unfair aspects of medical insurance is this: Patients can change insurance only during end-of-year enrollment periods or at the time of “qualifying life events.” But insurers’ contracts with doctors, hospitals, and pharmaceutical companies can change abruptly at any time.
Congressional Doctors Lead Bipartisan Revolt Over Policy on Surprise Medical Bills
By Michael McAuliff
November 17, 2021
KFF Health News Original
Congress last year shielded consumers from unexpected out-of-network charges, but hospitals and doctors have decried the arbitration plan put forward by the Biden administration for negotiating these bills as favoring insurers. More than 150 members of the House agree.
The Big Squeeze: More Enrollees and Smaller Networks Plague Some ACA Plans
By Julie Appleby
April 6, 2023
KFF Health News Original
Despite record enrollment in health insurance plans under the Affordable Care Act, some consumers who bought coverage and agents who helped them do so have had a tough start to the new year: Many say it’s hard to find an in-network doctor or hospital.
Lose Weight, Gain Huge Debt: NY Provider Has Sued More Than 300 Patients Who Had Bariatric Surgery
By Fred Schulte
April 20, 2023
KFF Health News Original
The private equity-backed practice has been known to demand more than $100,000 in charges or penalties. One patient is fighting back.
At Urgent Care, He Got 5 Stitches and a Big Surprise: A Plastic Surgeon’s Bill for $1,040
By Rachana Pradhan
August 2, 2021
KFF Health News Original
The Biden administration is weighing how to treat urgent care clinics as part of broad regulations banning surprise, out-of-network medical bills. At the heart of the matter: What counts as an emergency?
Your Doctor or Your Insurer? Little-Known Rules May Ease the Choice in Medicare Advantage
By Susan Jaffe
March 29, 2024
KFF Health News Original
Disputes between hospitals and Medicare Advantage plans are leading to entire hospital systems suddenly leaving insurance networks. Patients are left stuck in the middle, choosing between their doctors and their insurance plan. There’s a way out.