Recently, residents like myself in Colorado Springs, Colorado, encountered a new type of notification from healthcare providers concerning billing practices that may indicate a shift towards greater transparency in medical billing. Specifically, an imaging center informed us that for upcoming procedures, we should expect two separate charges: one for the use of facility resources and another for the medical professionals conducting the examination. It was further noted that some or all of these charges might not be covered by health insurance, advising us to verify coverage beforehand.
This preemptive notification sparked curiosity about whether it was a legal obligation or an exemplary demonstration of customer service—a rare find in today’s healthcare scenario. Prompted by this inquiry, I delved into the legal frameworks in place both federally and in Colorado that aim to prevent unexpectedly high medical bills, often referred to as “surprise billing.”
Surprise medical bills can occur when patients receive care from providers outside of their insurance network, which they often do not choose intentionally. This is especially common in emergency situations or during surgeries at hospitals where not all staff are in-network. Both federal and state laws mitigate the burden on patients by capping out-of-network charges to what would be billed if the services were in-network. For example, treatment received in an emergency room, regardless of the network status of the involved professionals, would be billed at in-network rates.
Both the federal and Colorado laws include mechanisms for resolving disputes between out-of-network providers who wish to charge more and insurance companies aiming to pay less. During such disputes, these regulations ensure that the patient is not caught in the fiscal crossfire, thus easing the potential financial strain on the individual.
The basis for issuing such billing notifications likely stems from compliance with these laws. The No-Surprises Act part of Colorado’s legislation was initiated in 2019 and came into effect on January 1, 2020, whereas the corresponding federal legislation was enacted later, tucked within the extensive Consolidated Appropriations Act of 2021, effective from January 1, 2022.
For those seeking more information on these laws or guidance on handling surprise billing issues, resources such as the Colorado Division of Insurance and the Colorado Consumer Health Initiative are available. These organizations provide invaluable assistance and information reflecting deep engagement with the intricacies of healthcare legislation.
Ultimately, in my household, the decision on how to handle the notification of potential dual billing was to disregard it, leaving the matter to our health insurance provider to manage. This scenario underscores a larger dynamic within the healthcare industry, where patients often have to navigate complex billing structures and legal protections, with varying degrees of personal involvement and understanding.
As a business columnist and counsel with Flynn & Wright LLC in Colorado Springs, I continue to observe and analyze these developments, aiming to offer insights that might help others navigate the costly and complicated realm of healthcare.
Disclaimer: This article was automatically written by OpenAI. The details, including individuals, facts, and circumstances mentioned, may be inaccurate. Requests for corrections or retractions can be sent to [email protected].