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With all the travel advice I’ve been sharing with you, particularly on the USA, I’d like to stress one crucial point today: the importance of taking out travel insurance if you’re visiting the USA, and if you live there like I do, of having health insurance covering at least emergency hospital care.
Emergency appendicitis: an astronomical bill
In a previous article, I described the symptoms of an appendicitis attack and the dangers if it isn’t treated quickly. But here, I’d like to address another equally shocking aspect: medical costs in the United States.
Unlike the French healthcare system, American fees are unpredictable and often exorbitant. For example, in my case, the charges were billed by several different entities:
- The hospital billed its own services.
- The surgeon sent a separate invoice
- The anaesthetist sent a 3rd invoice
- And a doctor for a blood test, if I’ve understood correctly, will send the 4th invoice.
This fragmentation of charges makes it difficult to understand the total cost, and it’s easy to end up with a colossal sum.
27 hours in hospital: $120,000 for an operation
After my admission to the emergency room, everything happened very quickly: scans, diagnoses, discussions with the doctors, then the operation. What I didn’t realize until later was that those 27 hours in hospital were to become the most expensive of my life.
The total bill? $120,000!
Fortunately, my insurance covered a large part of it, but I still had to pay about $10,000, which is still a lot of money, and incredibly expensive. Imagine if my health had worsened and I’d had to spend several days in hospital, what would have happened financially?
The problem of In Network and Out of Network
Insurance here at home has a few things I didn’t know, coming from France: what’s in network and what isn’t! On the way from the doctor who told me to get to the ER as soon as possible, I took the time to call the insurance company to confirm that the nearest hotel was indeed In Network (basically, insurance network partner).
I couldn’t drive long, exhausted, I had to keep things simple, on the phone the insurance company confirmed that the hotel was In Network, at which point I said to myself ok I can now just think about getting better, well for a few hours…
Of the 4 invoices received that I mentioned above, 2 were Out Of Network, so not really covered by my insurance, for a remaining amount of around $10,000 each, can you imagine the amount guys?
After doing some research, in the case of a life-threatening emergency that doesn’t allow you to choose another doctor or hospital, there is protection here in the USA called the NO SURPRISE ACT, but what is it exactly?
The No Surprises Act (NSA) in detail
The No Surprises Act (NSA) is a U.S. federal law designed to reduce surprise medical bills by helping patients understand their healthcare costs in advance. The law took effect on January 1, 2022.
In particular, it protects against :
Surprise medical bills
If you are covered by insurance through your employer, a Health Insurance Marketplace®, or an individual contract taken out directly with an insurer, the new rules introduced by the law provide several protections:
- Ban on surprise bills for emergency servicesYou can no longer receive surprise bills for most emergency care, even if it’s provided out-of-network or without prior authorization.
- Limitation on out-of-network costs for emergency services and certain non-emergency careAdditional out-of-network charges, such as coinsurance or deductibles, are prohibited for these services. You will never pay more than standard in-network charges for these services.
- Out-of-networkproviders (for example, anesthesia or radiology) working in a covered facility can no longer charge out-of-network fees or impose balance billing for their services.
- Transparency and patient consentHealthcare providers and facilities must provide you with a clear document explaining your protections against surprise billing. This document must also indicate
- The steps to take if you feel your rights have not been respected.
- That you must give explicit consent to waive these protections and accept out-of-network billing.
As regards this 4th point, I wonder what the legal validity of such a consent is. I was in such a bad state that I couldn’t even read or concentrate, I was folded in half.
To this day, I’m still negotiating to find a solution.
Balance billing
When a provider bills a patient for the difference between the amount covered by insurance and the total cost of the service, it’s called balance billing.
The No Surprises Act (NSA ) generally delegates enforcement to the states. However, if a state is unwilling or unable to enforce it, the federal government may step in. Some states also have their own laws on surprise billing, provided they guarantee a level of protection at least equivalent to that of the NSA.
If you have any questions about the No Surprises Act , you can contact the Centers for Medicare & Medicaid Services Help Desk at 1-800-985-3059 or file a complaint directly online.
