Surprise medical bill ban doesn’t cover some crucial elements. Here’s what to know

Margot Sanger-Katz:

So, this also provides a lot of consumer protections in that situation.

So, if you are going to have a scheduled surgery, say you are having a knee surgery or something like that, the hospital where you are having the surgery is covered by your insurance, and the surgeon who is doing the procedure is covered by your insurance, then you don’t have to worry about anyone else. There should not be a situation in which, say, an anesthesiologist is not covered or a radiologist.

Those people are all going to be covered by your insurance. If, for some reason, there is some special doctor that you really want to be there who your insurance doesn’t cover, there is a procedure where you can basically sign a form where you say, I’m going to allow this person to send me an extra bill.

But you have to get notice of that in advance. You have to sign the form. And the form needs to tell you two important things. It has to tell you how much they think it’s going to cost, so that you are not surprised when you get that bill. And they also need to tell you, here are some doctors that will take your insurance that you could choose instead.

So, if you are in a situation where you are having a scheduled procedure and someone gives you that form, look at it really closely. Consumer advocates that I talked to said there are very few situations in which it’s really in your interest to sign that form. The hospital needs to be able to provide you with options who will be covered by your insurance.