Aldeen’s Sunday Bathroom Edition, Winter Edition, Vol. 1, Article 3

Given the current litigation over the implementation of the No Surprises Act, I thought it worthy to highlight this “Bill of the Month” from NPR which highlights a “loophole” when a facility fails to provide the necessary documentation to support an ER claim.

Perhaps instead of relying on the NSA, states simply require a surety bond as a condition to maintain a not for profit hospital’s tax exempt status. The charitable facility can balance bill anybody as long as the bill is 100% accurate and complies with all laws. They would never be able to do it and there would be a run on the surety bond and the facility would have to make a significant strategic decision moving forward regarding its balance billing practices.

“… Patients who need prompt lifesaving treatment often don’t have time to find an in-network hospital. In the past, health plans sometimes have said they would pay for emergency care even if it’s out of network.

The No Surprises Act now makes this a legal requirement in every state. The provider and insurer are supposed to negotiate a reasonable payment, leaving the patient out of the equation.

But what if the insurance company denies the care is for an emergency? Or the hospital doesn’t supply the paperwork to prove it?

That’s what happened to the Bulls. Cigna said it lacked documentation that the NICU care for the twins qualified as an emergency.

See previous edition of Aldeen’s Sunday Bathroom Edition – Winter Edition, Vol. 1, Article 2 here.

To establish that there was, Cigna asked for daily progress notes and other medical records on the infants. The Bulls tried to get the hospital to comply. Cigna kept saying it hadn’t received the necessary documentation… .”

Bill of the Month: $80,000 surprise could still happen under new law : Shots – Health News : NPR

Article By Doug Aldeen, Esq., GHFAP (Godfather of Hospital Financial Assistance Policies & Other Things Too Numerous To List Here – it’d take the entire alphabet)

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