Personal Injury Claims During a Pandemic and Beyond: “The (Surprise) Billing Stops Here”

Austin LiPuma

It took a global pandemic that continues to wreak havoc on the Nation but it appears, at least at the time of this post, that one practice will finally be curtailed: surprise billing. The prolific practice of “surprise billing” often gob smacks clients who are already in physical pain. Even worse, the common and well substantiated belief that there will be an excess bill, acts as a deterrent for clients to seek reasonable, necessary medical treatment following an incident.

So what is surprise billing? It’s largely in the name. The classic paradigm is when an insured patient (injured person) is admitted to the emergency department for a host of complaints. In order to address the litany of complaints and adhere to the applicable standard of care, attending physicians will typically order a battery of tests. These tests (commonly x-rays/CT scans) do not come on the cheap. This is especially true when provided treatment is labeled with perhaps one of the most destressing phrases one can see/hear: “out-of-network.”

A study performed by the Kaiser Family Foundation found that nearly one in five in-network hospital visits led to out-of-network charges. It goes without saying who is ultimately responsible for payment and here in lies the insidious nature of these charges. Far too often one of my clients is hurt through no fault of their own, is rushed to the nearest emergency department, timely presents proof of health insurance, and then is still stuck with a surprise bill for charges that fell outside what insurance will cover. This practice is acutely harmful not just to the injured person but extends to at-fault insurance carriers and third parties that may be legally responsible for compensating the injured person.

Finally, after years of debates, it appears that a solution is imminent. Congress committees on both sides of the coin have just recently and unanimously reached a deal regarding the fittingly titled “No Surprises Act.” The essence of the act removes the gratuitous, financial burden on the patient and instead places it onto the health insurance carrier and the applicable medical provider. In other words, the patient is only responsible for the in-network charges and the “surprise” shifts to the insurance carrier and provider to sort out. While not signed into law, there appears to be a legitimate chance that this act will be included as an offset in the new spending bill for 2021.

Regardless of the reason, having to go to an emergency department is already an objectively unpleasant experience. Receiving a surprise bill for thousands of dollars roughly a month later only compounds that experience. After the year we’ve had collectively, let’s hope we strive to stop the unpleasant surprises looking ahead.