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New federal law protects from surprise out-of-network medical bills

The new law requires providers to give clear, upfront information about billing and the appeal process if there is a problem down the line.

OREGON, USA — A federal law is now in effect to protect consumers from surprise medical bills accrued out of network.

In 2015, KGW investigated a number of cases affecting people in Oregon and Southwest Washington. 

"It's been a nightmare," one person described.

People were getting stuck with surprise medical bills that they thought would be covered in-network by their insurance.

"For the common person, this isn't fair," another person told KGW investigative reporter Kyle Iboshi in 2015.

Another case involved Jamie Hansen in Washington, who received a $96,000 medical bill for her son's emergency care.

"I'm thinking I'm going to have to sell my house," Hansen said at the time.

The practice is called "balanced billing."

RELATED: Even after insurance, Washington family faces $96K medical bill

When someone goes to a hospital, that person may be treated by a doctor who accepts the correct insurance. However, if someone else comes in to help or if a patient has to seek other services in the same facility, the patient could end up with a separate bill from that provider.

Some providers who work in the same facility are not always in the same network.

"It has ruined people's lives," said former president Donald Trump. 

In late 2020, Trump signed the No Surprises Act, banning the practice of balanced billing. The federal law took effect on January 1, 2022.

RELATED: Ban on 'surprise' medical bills to take effect Jan. 1

"It's really going to protect consumers of health care," said Dr. James Polo, executive medical director of Regence Blue Cross Blue Shield of Oregon.

Polo said with the new law, providers must now give clear, upfront information about billing, network coverage, and the appeal process if there is a problem down the line.

"When you go to a hospital, you just assume everybody works for the hospital, and that's just not the case," Polo said. "Those providers and those health care systems have to figure out how to appropriately work together, but without moving that expense onto the consumer."

Polo explained the out-of-network pitfalls are still there, but transparency is now supposed to get better.

His advice is for consumers to always ask these questions upfront:

  • What is the cost of care?
  • What is covered in-network?
  • Are any out-of-network services involved that will add to the cost?

"We wouldn't hesitate to ask those questions at a restaurant [or] car dealership," Polo explained. 

Some providers may still make billing mistakes as they integrate the new policy, Polo said. Consumers can file complaints on CMS.gov.

In 2019, Gov. Jay Inslee signed a similar protection against surprise medical bills, which was great news to Jamie Hansen.

RELATED: Washington governor signs surprise medical billing law

"So many people have this happen," she said.

Now, the same protections apply everywhere.

"It means they don't have to worry as much," Hansen said.