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How Idahoans can protect themselves against surprise medical billing

One woman said her mom's doctor's office was unaware of the No Surprises Act, which ensures more people know how much medical procedures cost beforehand.

BOISE, Idaho — A health scare over Memorial Day weekend put Brandi Van Etten's mom in the Saint Alphonsus Trauma Center for six days. 

"Her occipital bone had to be repaired, and then the ligament in her eye," Van Etten said. "Also, she had a slight brain bleed. And so, it was a fairly significant accident." 

Van Etten said her mom's recovery led to another surprise, too — this time on paper after an oral surgeon in Eagle charged her $8,000. 

A few months later, Van Etten said she learned about the No Surprises Act during an unrelated hospital visit. The federal law, which helps more people understand how much medical procedures cost before they get them, was enacted in January 2022. 

Shannon Hohl, Idaho Department of Insurance market oversight bureau chief, said the act applies in most medical emergencies and some outpatient situations. It also protects people without insurance so they can get a good faith estimate. 

However, there are some exceptions. Hohl said the law does not typically apply to dental, vision or hearing plans. It also does not apply to people on programs like Veterans Benefits, Medicaid or Medicare. 

Those programs already have protections against surprise medical billing, she said. 

"We're mainly talking about major medical plans," Hohl said. "So, that's your employer benefit plan or your product that you buy on the exchange." 

Van Etten said her mom has Medicare with supplemental insurance. But Van Etten still asked her mom's doctor's office about the act, and they did not know about it, which she called "astonishing."

"If this doctor's office didn't know about it, and if what they're telling me lots of the other trauma docs didn't know about it, either my guess is that they don't have any policies or things in place that are protecting, notifying educating and protecting their patients." Van Etten said. 

Hohl said the act is still fairly new, which means smaller providers might still be learning the information they need to tell patients. 

In most cases, Hohl said providers should automatically offer a good faith estimate to people without insurance. However, it is always a good idea for patients to ask about the act to help raise awareness and discussion about whether the law applies to their situation.

She encouraged people to call the Department of Insurance if they have any questions about the act or are worried they might have been charged too much. 

"That can give us the opportunity to help providers understand what the expectations are and help anybody who's having an issue, either getting that good faith estimate or resolving a dispute with it," Hohl said. 

After Van Etten's interview, she told KTVB her mom's doctor's office is refunding them because of a separate billing error. But she said her family would not have gotten the refund without questioning the office about how much they were charged. 

Van Etten said she just wants others, protected under the act, to advocate for themselves so they are not surprised by hefty medical bills, too. 

"I think the act is a great idea so that everyone can be aware of what things cost," she said. 

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