Surprise Medical Bills in the US: Everything You Need To Know

Last Updated on November 16, 2022

| Posted on November 16, 2022

Accessibility to quality healthcare services is among the prime necessities in both Canada and the United States. Unfortunately, this accessibility is often available at a high cost, especially in the US. According to the Canadian Institute for Health Information, the average healthcare cost in Canada is $7,000 per person. While in the US, it is over $10,000 per person. By the next decade, this cost is expected to grow at 5.5% per year.

This rising cost is undoubtedly impacting healthcare services and patient care. As US patients do not directly pay hospitals the cost of treatment but involve insurance companies, it is creating a financial burden on them.

In situations where the treatment is related to an accident injury, the wage loss of a few days or weeks burns the holes in the patient’s pocket. In the worst-case scenario, it restricts the person from receiving complete treatment.

This leads to a burning question.

Why Are Medical Bills So Expensive in the United States?

Well, there are several factors that lead to pricey bills, such as industrial price, rate regulation, type of treatment, etc. However, the major cause creating a buzz is a surprise medical bill. As well, many folks simply haven’t explored ways to keep their medical bills down.

As the name suggests, a surprise medical bill is an invoice including the cost of out-of-network service. Not every healthcare facility, ambulance, anesthesia, or laboratory test is provided by your in-network hospital during a medical emergency. Therefore, the cost associated with these extra and out-of-network services is charged separately from the patient.

This practice is also known as “balance billing,” as you’d have to pay the difference between the total medical bill and the amount paid by the insurance company. For instance, if the treatment cost is $700 and the insurance company pays $400 for the in-network treatment, the rest $300 will be paid by the patient as balance billing.

The reason why surprise medical bills are causing chaos is that patients do not know about this expense until they are billed.

It is noteworthy that in some scenarios, medical institutions deliberately charge extra money from the patient. It is done by providing unnecessary treatment from out-of-network service, misdiagnosing the condition, or manipulating the accounts to make the invoice expensive.

These scenarios are a part of medical malpractice and not necessarily a surprise medical bill. So, many victims seek the services of a medical malpractice attorney to fight for their rights and seek compensation. They can also claim non-economic damages if the malpractice took a toll on their well-being.

No Surprise Act

In the US, the No Surprise Act (NSA) came into effect in January 2022. It protects the patient from the practice of surprise billing if they have health insurance coverage or a group health plan. It also prohibits:

Unexpected bills for emergency services from a facility or provider that is not in your provider’s network and without your permission.
Out-of-network cost-sharing, such as coinsurance or copayments. (Applies to all emergency as well as non-emergency procedures.)
Out-of-network fees and unpaid balances for extra services rendered at an in-network facility by non-network providers, such as radiology or anesthesia.

Medicare Protection Amendment Act in Canada

In Canada, balance billing is known as an extra bill. This practice is decades old and created a threat to the federal government by establishing a two-tiered Canadian healthcare system.

Therefore, the government passed the Canada Health Act in 1984, which included provisions to discourage user fees and extra billing by levying financial penalties. The act further offered universal and comprehensive health coverage for all Canadians.

Continuing the healthcare accessibility approach, in 2003, The Medicare Protection Amendment Act became operative. This prohibited extra billing for medical services and diagnostic tests deemed medically necessary and covered by the provincial Medicare system. In Canada, all provinces and territories are protected by this act. In fact, each province and territory has its own healthcare system which is funded at both the provincial and federal level, making basic healthcare virtually free for its citizens.

The government declared its intention to implement existing laws more strictly in 2018 and to start levying fines for overcharging for diagnostic treatments that are medically required.

How Do Both Acts Protect The Patients?

Though both acts were imposed differently, the prime intention of both countries is to protect the patient from wrongful acts. Additionally, it makes healthcare affordable and accessible for low-income groups. Of course, the approach is distinct on numerous parameters and needs to be imposed strictly. Raising awareness of medical malpractices and inaccurate billing is critical so patients can exercise their rights.

In Conclusion

Healthcare accessibility is essential to prevent diseases, promote well-being and accomplish health equity in both the United States and Canada. However, practices such as surprise medical bills put a hold on these goals. Fortunately, the government measures the No Surprise Act and Medicare Protection Amendment Act to restore faith in the federal system by assisting patients. Regardless of your place of residence however, it is especially important to invest in additional health insurance.

In the US, this will protect you from high bills related to doctors, diseases and emergencies, and in Canada to provide access to services that focus on vision, dental and many other preventative measures.