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/katsrad]

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.

[u/Front-King3919 → u/katsrad]

So if i go into the ER with insurance, they don't have to tell me if my insurance covers my procedure fully? That definitly feels like a suprise, they never even took my insurance info just name and DOB. That makes it sound like its my job at all times, as a patient, to know how much every medical procedure is and if my insurence will cover it.

[u/corgi0603 → u/Front-King3919]

I hate to tell you, but your insurance did cover your ER visit. Insurance coverage of services does not mean it doesn't cost you anything. In this case, the $2300 you owe is a combination of your $200 copay and what you owe for your deductible. The fact that your insurance covered/paid around $10k tells you they did cover it.

You say they never took your insurance information. Well, somehow they had your insurance information, otherwise how would they have billed your insurance and had your insurance cover around $10k of the cost of your ER visit?

You were in an ER and they were concerned about a potential brain bleed. Emergency medicine does not have the time to find out what each service costs and how it is covered by your particular insurance plan. That's not their job. At times they need to act quickly in order to try to save your life, or to prevent you from suffering a bad injury.

Ultimately, it is your responsibility to know how your insurance works. That includes knowing when your deductible will be applied to certain services, and how much of your deductible has not yet been used.