No Surprises Law – Must providers resubmit claim?
Hello!
I am trying to understand how the no surprises act is supposed to work. Would love a gut check.
Insurance Details:
United Healthcare Select Plus PPO HDHP CA
$3k/$4k ded/max (in network)
$5k/$6k ded/max (out of network)
$4k Health Reimbursement Account (for applying towards out of pocket max, which got drained paying out of network doctors)
I had a nasty ski crash back in January. Got taken to the ski clinic, then to the emergency room in the city. I had some nerve damage, so they got pre-op stuff done for surgery that night, and called me at 5am the next day to have me in for surgery. Pretty clearly all emergency services.
Then bills started rolling in and it turned out the hospital/provider were out of network. So I got billed ~$4k for surgery, and $25k for hospital fees. YIKES!
I learned about the No Surprises bill and tried every avenue to get it applied. Finally after WEEKS of trying, I convinced the hospital that it applies, and I got a new bill for ~$760 for hospital fees. Excellent.
However, as I found out today, the hospital didn’t actually resubmit the claim coded as emergency services, so my insurance company is still running those services as out-of-network and thus not applied to my out of pocket max/deductible.
Now of course I am grateful to not have the bill for $25k, but this still means I will have to pay what they bill me.
I actually have an account as part of my insurance that pays my bills all the way up until my out of pocket max, so this is the difference between me paying $0 and a few thousand.
So my question is, is the way the hospital handled this legal? They apparently didn’t resubmit my claim at all, just adjusted the bill. It seems to me that it’s in their best interest to resubmit it, since then the insurance company would be on the hook? Is there anything I can do or say to get the hospital to resubmit these claims as emergency services?
I’ve tried a ton of things already and losing the will to fight, but it’s probably worth a few thousand dollars to me to try a few more things.
Thanks!