What are surprise medical bills? 

Previously, if you had health insurance and received care from an out-of-network provider or facility, even unknowingly, your health plan may not have covered the entire cost. This could have left you with higher costs than if you received care from an in-network provider or facility.

What are the new protections if you have health insurance? 

If you have coverage through an employer, marketplace, or individual plan, PDEC is required to give you an easy-to understand notice explaining the applicable billing protections., who you can contact if you have concerns that a provider or facility has violated the protections and that a patient consent is required to waive billing protections.

What if you do not have health insurance or choose to pay for care on your own without using health insurance (“self-paying”)? 

If you do not have insurance or your self-pay for care, in most cases these new rules make sure you get a good faith estimate of how much your care will cost before you receive it.

You Have the right to receive a “Good Faith Estimate” to better understand costs

Under the law, health care providers need to give patients who do not have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like diagnostic and lab tests and office visit fees.

When you schedule an office visit or lab service at least 3 business days in advance, make sure you request a Good Faith Estimate to be sent to you within 1 business day after scheduling. If you schedule at least 10 business days in advance, make sure you request a Good Faith Estimate to be sent to you within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule a visit or service. If you do, make sure PDEC gives you a Good Faith Estimate in writing within 3 business days after you ask.

Make sure to save a copy or picture of your Good Faith Estimate and the bill.

What if I am charged more than my good faith estimate? 

For services provided in 2022, you can dispute a medical bill if your final charges are at least $400 or higher than your good faith estimate, and you file your dispute claim within 120 days of the date on your bill.

Where can I learn more? 

Visit CMS.gov/nonsurprises or call the help desk at 1-800-985-3059 for more information.

If you receive a surprise bull you believe is not allowed under the new lay, you can file an appeal with your insurance company then ask for an external review of the company’s decision after the initial appeal is completed with your plan.

You can also contact Oregon’s Division of Financial Regulation to speak with a consumer advocate or file a complaint in any of the following ways:

            Phone: 888-877-4894 (toll free)

            Email: DFR.InsuranceHelp@dcbs.oregon.gov

            Website: https://dfr.oregon.gov/help/complaints-licenses/Pages/file-complaint.aspx