(WSPA) – If you have ever opened a hefty bill for a health service you thought was covered by your insurance, you know the pain of a surprise medical bill.
A recently enacted federal law has tried to curb that, but as we found in this 7NEWS Consumer Exclusive, for many families it falls short, leaving you with services that are not covered, and not cheap.
Take 20-month-old Logan Arnold, for instance. He was diagnosed at birth with a hearing issue that his mother, Jessica Arnold, said is getting progressively worse.
As more audiologist visits became necessary, Arnold said she learned a harsh reality about her family’s health insurance, almost all his hearing-related medical services including hearing aids are not covered.
“I was completely amazed, it really caught me off guard, because there is no way, especially a baby.”
The Greenville mother-of-three also sympathizes with the older adults who lose their hearing and are stuck with high out-of-pocket costs.
“But it is a little bit different because you develop language,” she said, as she looked at her boy who she says cannot hear speech decibels without his costly hearing aids.
Maureen Krantz can certainly sympathize.
“I feel cheated, I don’t know where we are going to get the money,” Krantz said as she showed 7NEWS photos of her husband, Tim, in the hospital after he suffered a brain injury from a snowmobile accident last year.
Krantz said the six-minute ground ambulance ride turned out to be with an out-of-network provider, leaving her and her husband stuck with nearly $1,000 dollars in bills, on top of the other co-insurance bills she got for the surgery and air ambulance.
“Now a year later we’re living through new trauma, and it’s medical bills,” Krantz, who has had to run their construction business alone since her husband’s accident, said.
No Surprises Act
The Federal No Surprises Act went into effect in 2022 and gives consumers “new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers,” according to the Centers for Medicaid Services which oversees enforcement of the law.
The new rules aim to protect consumers from excessive out-of-pocket costs by mandating most emergency services be covered without prior authorization “regardless of whether or not a provider or facility is in-network.”
What’s not covered
However, the law still does not protect against some common and costly surprise medical bills like:
- ground ambulances
- urgent care facilities
- hospice facilities
- drug treatment centers
- many non-emergency surprise bills
Some states offer additional protections beyond the Federal Law, and while S.C. does not have a “no surprise billing law,” that doesn’t mean the state can’t help.
Michael Wise, the Acting Director of the South Carolina Department of Insurance (SC DOI), encourages anyone who has questions about appealing a bill with your insurance company to contact the department.
If an appeal is denied, the agency can help you go to the next level.
“We can assure that companies are doing what they are supposed to be doing. So, if there is an appeals process internally that has been exhausted then the policyholder can come to us and we can help them navigate asking for an independent external review,” Wise said.
If your insurance is denying the claim, South Carolina residents can contact the Office of Consumer Services at SC DOI by calling (803) 737-6180 to speak with an Insurance Regulatory Analyst. You can also email your question to email@example.com or file an online complaint.
In addition, to help from the state, the new Federal law also establishes a National Consumer Complaints system for surprise medical bills.
This method is most effective if your issue is with the provider or healthcare facility.
In those instances, you can contact the federal government by filing a complaint or by calling 1(800) 985-3059.
One example of when this might occur is if a provider violates the No Surprises Act and tries to charge you more than the “in-network” cost for a protected service, like air ambulance, radiology and anesthesiology, a practice often referred to as “balanced billing.”
Krantz, who is also facing a $4,000 out-of-pocket charge for what the air ambulance company says is her portion of the $25,000 bill said she plans to use the National Consumer Complaints system to make sure that overage is not the very balanced billing that is no longer permitted under the No Surprise Act.
She said she is grateful her husband is learning to walk again.
However, she knows unless states enact their own additional protections, or Congress amends the law, people like her will continue to suffer for things like ground ambulance bills that are left entirely for the patient to cover.
SC Hearing Aid Bill
Meanwhile, Arnold is hopeful a new bill at the South Carolina Statehouse may soon mandate insurance companies cover most medical costs for hearing issues.
She said she will advocate on behalf of not just her son, but other children for whom hearing aids and implants are essential to not just communicate but thrive.
“We love him, we’re going to do everything that we can no matter what,” Arnold said.