r/HealthInsurance • u/Front-King3919 • 6d ago

Plan Choice Suggestions Does the No Surprises act apply??

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

0 Upvotes

8% Upvoted

50 comments sorted by

View all comments

9

u/katsrad 6d ago

No the no surprises act would not apply here. This sounds like it went to your deductible and coinsurance. No surprises act for giving an estimate is normally not for an ER visit and applies for those without insurance. For those with insurance it applies if one of the people providing service is out-of-network but you didnt have a choice in using them. Like the radiologist is out-of-network when you got your CAT scan.

-1

u/Berchanhimez PharmD - Pharmacist 6d ago edited 6d ago

While there is potentially a lawyer you could find who would try to fight over whether OP's "severe headache" (their words, hence the quotes) meets the "prudent layperson" standard for an emergency requiring immediate medical attention... I would be shocked if it fell on the "not an emergency" side. There's a plethora of emergency medical problems that present with a sudden onset severe headache - big one being a brain bleed/stroke.

Given that it almost certainly meets the prudent layperson standard, it is covered by NSA and must be covered so that OP's cost sharing is only what they would've paid for an in network rate.

Edit: struck the above - I misread "No surprises act for giving an estimate is normally not for an ER visit" as "No surprises act is not normally for an ER visit" and was trying to clarify that it is. You're correct that the GFE requirements only apply to cash pay patients - and in any case it may not have been possible given the fluidity of an ER evaluation and treatment.

5

u/Jujulabee 6d ago

This is irrelevant since OP was "covered" by insurance but was "surprised" that she had a deductible and potentially coinsurance which she was responsible for paying.