Out-of-Network Medical Bills  – No Surprise Act Violations Class Action Investigation

The No Surprises Act recently established new protections against surprise medical bills from out-of-network providers that took effect on January 1, 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers, resulting in financial burdens when health insurance plans deny out-of-network claims or apply higher out-of-network cost sharing. Research supporting the Act indicates that this occurs in about 1 in 5 emergency room visits.

For consumers insured by employer-sponsored or individual market policies, these new rules require plans to cover all emergency and some non-emergency services either provided at an out-of-network facility or by an out-of-network clinician at an in-network facility. Out-of-network providers who render these services are prohibited from billing consumers more than the applicable in-network cost sharing amount. Before a health care facility can bill a consumer the balance for authorized out-of- network services, the consumer must receive at least 72-hour notice of the provider’s network status and an estimate of the expected charges and provide consent to receiving out-of-network care. The No Surprises Act also protects uninsured or self-pay consumers by requiring that health care facilities provide a good faith estimate of expected charges upon request or at the time the services are scheduled.

While it is the responsibility of health care providers and health plans to identify and cure protected bills, consumers must remain vigilant of surprise medical bills and seek relief if an out-of-network claim is denied or overcharged compared to in-network cost sharing standards. If you believe you were subject to a surprise medical bill, we encourage you to contact the attorney below to help you understand and defend your legal rights.

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Attorneys for this case:

Benjamin F. Johns