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Federal law aims to crack down on surprise medical billing

Nonprofit turns thousands into millions of dollars in medical bill relief
Nonprofit turns thousands into millions of dollars in medical bill relief(WBTV (Custom credit) | WBTV)
Updated: May. 10, 2021 at 4:01 PM EDT
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SAVANNAH, Ga. (WTOC) - A state law aimed at protecting Georgians from surprise medical billing does not protect everyone, but a new federal law could close the gap.

The new federal law, known as the No Surprises Act, will take effect in January of 2022. It’s aimed at cracking down on surprise medical billing that typically arise out of an emergency room visit.

But a consumer advocate says Georgians should not rest easy yet because the existing state law does not protect everyone.

“People in Georgia have protections from surprise medical bills if they are enrolled and insured by a plan that is regulated by the state of Georgia. So, it can be a little confusing as to whether the surprise medical billing protections apply to you,” said Patricia Kelmar, with Georgia Public Interest Research Group Education Fund.

The independent, non-partisan group has reviewed Georgia’s new law and found surprise medical billing can still happen to those who have private insurance.

Here is who is covered: Consumers with state-regulated insurance and those with Medicare or Georgia Medicaid or Veterans Affairs Health Care.

The law does not apply to self-insured plans, known as ERISA plans, which include most employee sponsored plans, Kelmar said.

So how do you know if you are covered under the law?

Kelmar advises to call your insurance company and ask, am I protected by a state regulated insurance plan?

If the answer is yes, these are your protections:

  1. Emergency treatment by an out-of-network provider or facility.
  2. Treatment by an out-of-network provider at an in-network facility which would normally be covered by your insurance.

Other advice the nonprofit offered is to always inspect your medical bills and ask questions before you agree to pay it.

South Carolina does not have a state law in place to prevent surprise medical billing, but will be covered under the federal law that takes effect Jan. 1, 2022.

Read the tip sheet below from the Georgia PIRG Education Fund:

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