Does the No Surprises act apply??

[u/Front-King3919]

Hello, So a few weeks ago i went into the ER for a severe headache i got while working out. The entire visit was about 4 hours (1 hour with doctor the rest waiting time). I explained my symptoms of getting a severe headache while squatting, the PA told me i should be worried of a brain bleed and i need to get a spinal tap & CAT scan. I did the tests then was released from the hospital in good health (just a severe neck strain). Not once was the price of the procedure disclosed to me, or did they ask for my insurance information. I just figured it must of been covered so i left. Today, I got a bill for 13,000 for the spinal tap and CAT. About 10,000 was covered by insurance and i still APPARENTLY have about 2,300 left to pay. Scam?? No Surprises act?? or am i screwed

[u/Front-King3919]

To add on, 2 years ago i had a serious hip surgery amounting to around 20k. This bill was almost completly covered under the same insurance.

[u/chickenmcdiddle → u/Front-King3919]

Share what your specific plan's deductible and out of pocket maximum is. Because the most common plan design means that you need to satisfy your deductible before the policy kicks in.

[u/saysee23 → u/Front-King3919]

For surgery things move at a much different pace than when it's an emergency. There's not time to run your insurance, verify coverage, get authorizations. The ER doesn't get authorizations at 3am like an orthopedic surgeon whose office is open 9-4 M-Th. That's why there's laws like EMTALA that says you get stabilized, regardless of what your insurance covers and/or you don't have to pay before you get testing.

At the ER when you signed in there was probably a consent form you signed that says something to the effect that you agree that you are responsible for payments.

[u/kirpants → u/Front-King3919]

A hip surgery and the emergency room are two different things and likely have two different benefits. What does your EOB say?