New state law protects Ohioans from surprise medical bills

A new state law has gone into effect that protects Ohioans from surprise medical bills. A similar federal law became law on Jan. 1, and the two new laws are expected to complement each other. Surprise medical bills typically range hundreds to thousands of dollars — and a recent national study indicates that unexpected medical bills, including surprise medical bills, lead the list of expenses most Americans fear they cannot afford. "I appreciate the work of the Ohio Legislature and representatives of the medical and insurance communities for coming together on this issue and for doing what is right for Ohioans," Ohio Gov. Mike DeWine said. "Nobody should end up with unexpected medical bills through no fault of their own." The law protects patients from receiving and paying surprise medical bills above the patient's in-network rate from health care providers for emergency care or, in certain circumstances, unanticipated out-of-network care, such as at an in-network health care facility from an out-of-network provider and including lab/pathology services. Cost-sharing amounts, which include coinsurance, copayments, and deductibles, are limited to the patient's lower in-network amounts. The Ohio Department of Insurance is responsible for administering and enforcing many of the law's provisions and addressing complaints from consumers who receive surprise medical bills. The department established a payment reconciliation process for health care providers and health insurers to work through billing discrepancies instead of surprise billing the patient. "We will be aggressive in order to protect consumers on matters relating to surprise medical billing," Ohio Department of Insurance director Judith L. French said. "I urge anyone with surprise medical billing questions or concerns to contact us." The department, which is conducting a statewide consumer education campaign informing consumers of their rights under the new law, created a surprise medical billing toolkit at www.insurance.ohio.gov to help consumers, health care providers, health insurers and other stakeholders understand the law and its requirements and to access the department's surprise billing services. The department's consumer hotline is 1-800-686-1526. A federal surprise medical billing law, called the No Surprises Act, went into effect on Jan. 1. The federal law and Ohio's law work together to protect consumers in surprise billing situations. The federal law's authors included U.S. Sen. Sherrod Brown, D-Ohio. "We know how much of a problem these out-of-control surprise bills have been and health care remains one of the most stressful costs families face," Brown said. "A patient can do everything right but still find themselves waking up from surgery, expecting to pay their standard co-pay, only to find out their anesthesiologist was out-of-network and they owe several thousand dollars in surprise bills." Brown continued: "This new law will make the costs of medical care more transparent and ban most surprise medical bills. It's a critical step that will help protect Ohioans from these surprise bills, giving them more control over the cost of their health care and the peace of mind to focus on their health and recovery, not exorbitant medical bills." Brown said any Ohioan, regardless of their form of health insurance, can visit CMS.gov/nosurprises or call 1-800-985-3059 between 8 a.m. and 8 p.m. any day of the week to ask questions or report a potential violation of this law.