it's my understanding that the affordable care act requires insurers to treat any emergency services (if covered at all) as in-network. can anyone explain either a.) how I am wrong, or b.) how this can be circumvented?
We ended up getting a >$2,000 bill for a 10 minute ambulance ride because the ambulance company was out-of-network. The ambulance company then had the audacity to send the bill to collections before the 30 day pay period even expired...
So yea, even if you have good insurance you can still get bit by these issues in emergencies! Unfortunately, this new bill does not even address the out of network ambulance issue.
If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts you pay.
That “if” condition is usually going to hold, so a lot of surprise bills come out even despite the ACA rule.
[1] https://www.verywellhealth.com/get-in-network-rates-out-of-n...
What really got to me was it was ER visit and the Doc(extortionist) spent maybe 5 minutes with me before having the nurse fix me up. After insurance $250 to hospital, and $2000 bill for the Doc.
This. Does anyone know if the Founding Fathers discussed the evils of complexity in law back during the conventions in Philadelphia? Is that a more modern day problem, or is it as old as parliament itself? I don't remember reading anything that said the dangers of complexity in law was on their radar.
Businesses are guaranteed to take advantage of complexities in law. I don't think this is well enough known. Any and every added complexity will therefore be taken advantage of, and should be considered in passing a law, and every law should have some type of way to "expire" itself, so that it can be removed (and the resulting complexity), when the reasoning for such law is gone.
Complexity around healthcare laws is the textbook example.
For instance, they may want to begin some of the long term maintenance of your new condition while you're still in the hospital. Whether the insurance company is successful or not, they may at least try to say this isn't covered.
Eventually, you and your loved one are dealing with one of the worst moments of your life, how much time do you have to fight all their attempts at not paying your benefits? Keep in mind the fights happen during business hours, and you just missed four weeks of work and need the job to keep the insurance you now need more than ever.
Laws that reduce the number of ways insurance companies can avoid paying will be helpful.
Just a note, if you're in the US and a loved one is injured or ill there is the Family Medical Leave Act which should protect your job (in the short-term). It's not a huge safety net but if someone needs it it does help.