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Welcome to the show everyone. As you all know I made it possible for everybody to talk about what they do on my show. And who doesn’t like to talk about themselves? That’s what’s cool about this show is you’re talking about you, not me. Now, we are live on Facebook. So I want to say hi to everybody out there. Like us and follow us, we’ll share the show later on. I’m gonna go in with networking right away. Another thing that you can do is put in “Networking Arizona” all spelled out right into the Facebook right there and watch us in here doing it live, right now. It’s really cool to watch a show on Facebook. Okay, I’m gonna go in with my first guest. Actually, their firm has been on with me for a very long time. I have with me Rita Gara and she is one of the partners of FR Law Group. Welcome to the show. Again, you were on once before. Get close to that so we can hear you. And you know, what I like is that every time you guys come on, there’s a little something different of the areas of practice in the same umbrella that you guys kind of talk about. So tell everybody a little bit about the firm, because it’s important that we talk about them, and then what we’re going to talk about today,
Yeah, thank you for having me today. So our firm, it’s a smaller law firm here in Phoenix. We’d like to say a small law firm but big on experience between the attorneys in our office. We have decades of experience primarily focusing in areas of insurance, litigation and construction litigation. So today, I thought it’d be a good idea to talk about a new law that went into effect in January of this year that will affect couple of different groups of people. And there could be a situation someday, where having an attorney to help you navigate some of the issues brought up by this new law could help.
I think it’s really important. So listen up everybody, because it can affect almost anyone, especially if you get into a situation. So this is first called, No Surprise Act.
No Surprises Act, correct.
Okay, No Surprises Act. And tell everybody a little bit about it and then how you can help.
Absolutely. So we’ll start with, it’s a federal law. And many states, including Arizona, have laws that provide similar protections. The way the federal law interacts with the state laws, it acts as it’s supposed to be a supplement to any state law, provided that the state at least provides as a basement level the protection provided by this federal law. So they could provide more protections, but at least everybody is afforded the protections that are contained in this federal act and No Suprises Act. So they’ve been working on this for a long time. But these particular protections go into effect January of this year 2022 and they actually changed significantly the way certain insurance coverages are going to work. So it’s going to significantly affect the pocketbook of the patients in a good way. It’s designed to provide consumer protection and the providers in terms of their ability to collect. So the general purpose was to protect the patient from, there’s two terms they use the surprise medical bill or balanced billing, and it also seeks to remove the patient from the disputes. It wants to have the insurance company fight it out with the provider instead of having the consumer in the middle trying to figure out “how do I navigate between these two?” The other thing it looks to do is provide a dispute resolution process between the insurance company and the provider. And by provider I mean it could be, you know, a doctor’s group, it could be a day surgery center, whoever’s providing the care, provide them a dispute resolution process that leaves the consumer out of it, but gives the provider an avenue to try to get its bill paid.
So before you came on the show, we talked a little bit about it. First, let’s talk about a consumer. How can that happen if they have insurance? Right? Let’s say they go to the doctors and they have a surgery. You had mentioned something interesting how you said they went to have surgery and they knew that everything was covered because it was covered under their insurance that they had a provider and it was all in there. Except when they did the surgery, the anesthesiologist who came in wasn’t.
So I think this is what they refer to when they talk about the Suprise bill and I think this is a “Supprise!” and not a good surprise. This is something that I think a lot of people have experienced. So you set up a procedure, you’re gonna go to an outpatient day surgery center, you check, you’ve done all your homework, you check your book, you call your insurance company, and the facility you’re going to is an in-network provider. And that’s as far as it goes, and you think you’re good. You know what your co-pay is, you know what percentage they pay out. So you have a reasonable expectation of what you’re going to be looking at, bill wise, when you get out. And then what the patient doesn’t contemplate is they go in, and then you have a radiologist who is out of network and anesthesiologist who is out of network. When you are going to have that elective surgery, whatever it may be, you’re picking the doctor who’s going to do that but you’re not picking all of these other players who provide.
That’s just one person in there.
And then the bill start coming in, now you’re getting charged at a non contracted rate because of course you’re in-network providers have a contract with your insurance company. And you’ll know, if you’ve ever taken the time to look at one of your explanation of benefits, you can see they oftentimes discount that bill by a significant portion because they have a contract. Well now, you’ve got multiple providers that are not contracted and there’s the surprise.
And they’re not discounting them, sure?
They’re not discounting it and then that leaves the patient with this giant bill. Oftentimes, people aren’t able to pay depending on the circumstances. So that’s one really common area that this bill seeks to protect and we’ll talk about the specific protection it provides. The other area is maybe not as common, but many people either have experienced it or know somebody who has. You’re in a in an awful situation where you are— perhaps you’ve traveled, I know a couple people who’ve this has happened to, but a woman who was on vacation for a daughter’s wedding and they went to… I can’t remember but it was like an island country. Small country, out of the country and not a lot of significant medical facilities available for anything beyond the kind of a typical health issue. So on vacation, they decide to go cliff diving and the woman jumps off a cliff and breaks her back and is put in this really small, ill equipped medical facility that can’t handle the surgery she’s going to require. And so they contact their insurance and they need to take what they call an air ambulance. It’s an ambulance, but it’s an airplane. It has medical staff medical supplies and that ambulance will take you in a medically safe manner to the nearest available medical facility that can handle the level of care that you need. There was another patient I’m aware of who was out of the country and it was during COVID had a heart related medical issue. And not only was the heart issue pretty significant and the medical facility he was at out of the country did not feel like they could handle the care he needed. There are also a shortage of COVID beds. So again, an air ambulance comes and picks that person up and sometimes it will take a couple flights. There’ll be a couple air ambulances. And so then in the middle of that significant injury, you’re not thinking how much coverage? What’s the bill? You’re thinking, “I don’t want to die”, “I don’t want a bad surgery”. There was a another woman actually who was in this circumstance and the doctor at this small medical facility was suggesting a leg amputation. And the patient was not sure that was the best advice. Called somebody back home to get a second opinion and they said “No, see if you can fly back to this facility.”
When you’re in that situation, there’s not things that you’re thinking about obviously. The questions can’t be asked and all of a sudden, you are in trouble. But they can help. Now we’re gonna go to a break when we come back, we’re gonna talk further and I’ll tell you a little bit of story that I know too. Their phone number 602-566-7425 It’s frlawgroup.com Hang tight, we’re gonna be back in just a minute.
So welcome back. You know, we’ve been talking to Facebook land out there and we haven’t even be able to really go through some of the questions, but so important. And I was talking about a couple of people that I knew the same thing had happened. Here’s the thing folks, we live in a whole different world today than what happened with in stories that I can tell you about. Unfortunately, you know, who needs this kind of what I call service? Right? And you need to be protected, you need to have somebody that you can call that you can count on that can help. You do consultations, free consultations. Maybe there’s somebody out there, maybe it’s you, maybe it’s someone that you know that has been dealing with something like this, where they can call. And well let me just say this about FR Law Group, I’m just gonna say they might be a smaller firm here but they have the big guns. They are the big guns because that’s who they were beforehand. And then they decided to open up the firm to offer that type of service to the regular guys out there.
Yeah. That’s right. And to be able to spend a lot more time, one on one and give more care and attention to a case. And yeah, what we were talking about before the break and then during the break that hits to the heart of what this act was trying to help prevent is when you are injured in this potentially life threatening situation, they don’t want you to have to worry about insurance coverage they want you getting the emergency help you need. So I’m going to go over now, the specific protections that this federal act applies to. One of the things we see as an attorney, a lot of times people aren’t coming to preventatively, they’re coming to you when the bad thing is already happened. And so one of the things we think is really important is that you are armed with information and that, you know either that this information is out there or that if there’s something you don’t understand, you don’t know how to get help guiding you through some of these issues. So with respect to the new protections, who these apply to are people who have health insurance through their employer, the through the Health Insurance Marketplace or an individual health insurance plan that you purchase directly from an insurance company. We can talk about if you’re an uninsured or self pay, because this act does address some issues with uninsured or self pay individuals. But with respect to those who qualify under their particular health insurance plans, these specific protections are, number one: a ban on surprise bills for emergency services. So what that means is it’s you’re not going to get penalized for going to an out of network provider and importantly, because we don’t always think about these things in the midst of a crisis, you’re not going to be penalized for not getting prior authorization. Now, I’ll just stop there for a second, because this is where sometimes—
You would think they made sure of all of that.
You would think. And I think some of where we’ve seen this come up in our office for example. And I think that some of these issues are going to survive even with this bill is, there’ll be challenges as to “did it constitute an emergency?” or “did you go to the nearest capable medical facility?” So these kinds of challenges, your always going to have new challenges when there’s a new law. But there’s also, even within these new protections, there will still be challenges.
To me that’s where an attorney comes in. And that is where you could find out well, what did you do? You need to find out all about the case. It’s all about the case. And so let me give out that phone number. It’s 602-566-7425. They do free consultations. They are located right here in Phoenix, but they do help people nationwide and you can check them out it’s frlawgroup.com.
Yeah, that’s right. And some of the other protections I’ll go over, it also bans out of network cost sharing for all emergency and some non-emergency services. You can no longer be charged out of network rates and balance bills for supplemental care by out of network providers who work at an in network facility. So that was a mouthful. but that goes to the situation we were talking about before. If you’ve gone through the trouble of finding an in-network facility, you cannot be charged out of network prices for any of the other people who provided you care. And that’s huge.
That’s huge, because I was just thinking when you said that. So you go to the hospital and everything was all set up, you had XYZ and you checked it out, and the anesthesiologist that was supposed to do it, couldn’t make it that day. It could happen. And then so of course they have somebody else on staff, and they bring that person in or whoever that person is. If they didn’t check or if somehow that is something like that can happen. How easily can that happen?
And you don’t always have control over who the facility brings in to work; they’re not all guaranteed to have that sort of contract with your insurance company. So you really, prior to this protection, you really didn’t have a way to manage that.
So no matter how much homework you do, this can still happen?
It could. If it does, you know who to call.
Right. And now the big thing is understanding these protections so that if you do get a bill and you think they have violated this new act that provides these protections and you need help navigating the process, you can give us a call. Because the other thing the other protection it provides is there are two different dispute resolution processes it provides. One of those dispute resolutions is going to be the insurance company and the provider. So you were the one who provided services, your bills not getting paid by the insurance company, there’s a dispute resolution process that you can ask for help navigating. And it’s important to understand that process, there is a rapid timeline on that and you don’t want to miss a timeline, you don’t want to miss—
Now this is the provider. Because we, of course we’ve been talking a lot about the consumer, but the providers too can get hurt.
Absolutely. The provider now is going to, you know, when you think before they had avenues to go after, the patient owed the bill. And if they can’t balance bill, they can’t surprise bill anymore. Their only outlet is to negotiate a settlement with the insurance company.
And when they have to do that, that you can’t do that on your own. Right?
It’s not wise to if you’re not familiar with the process way. There are a lot of ways to trip yourself up.
So that’s where they come in come in and represent. I’m sure when you talked and everybody thinks they can do that. This is a perfect example, say that you all think that you can do all sorts of things. But you know, they’re trained to talk to you in a way or ask you the questions that are going to trip you in a sense. But that’s where an attorney can come in, you know the law, you know how to talk, that’s what your that’s what you went to school for. You know?
And it’s new. All these procedures are going to be new. And so everybody’s gonna be figuring it out and it could affect your opportunity to collect. And I know, we’re running, we’re running close to the end here. So I’ll really quickly mention another important area and that is the protections for the uninsured.
Oh very important, there’s a lot of people that are not.
So one of the biggest changes that this provides for them is if you are going in for a procedure and you don’t have insurance or you’re choosing to self pay, you you can request a upfront or a good faith estimate of what the procedure is going to cost you. Usually, you’ll get it within at least three days prior to your scheduled procedure—
I want to know way in advance, I’m sorry. Go ahead
And decide if you can do it. And they will have to itemize for different providers. And one of the important things is, if that good faith estimate per individual provider, not in total, if the dollar amount that they’re billing you differs by $400 or greater, you can dispute the bill. Doesn’t necessarily mean you’ll be successful buut again, that’s an issue where there’s gonna be conflict and where having an attorney can help. Why did this bill exceed it? Was there a good reason for it? Was it something that was not foreseeable?
I’m sure there’s so many people out there, I am absolutely positive, that there are a lot of people that can relate to this hour. They know somebody that’s been going through this. Here’s the worst part is, as a person, I don’t care if it’s a provider or not. It doesn’t matter when you’re dealing with something like this, it’s your anxiety level. I mean, you know, especially when you’re looking at those big dollars, because they are. They charge and enormous fees.
And you’re talking big money you’re talking about the insurance company might have their own appeals process, you’ve got timelines. So it can be really overwhelming on top of which most of us work and it can feel like another full time job that you have to stay on top of it. And that’s where we are there.
You need an attorney. Especially for sure and this kind of a thing, definitely. Their phone number is 602-566-7425. They do free consultations. They’re located right here in Phoenix, but they do help people nationwide. Their website is frlaw.group.com. Final words for today? I could talk about this all day long.
It is crazy. I think that the final word is just you know, the biggest thing is to educate yourself and if you want to help we’re here to help navigate you through these things and you don’t have to do it alone
And anybody that might be going for surgery right now, I mean you know you have some come up, have them do a consultation. Make sure to do your homework, but make sure that you have somebody that you can talk to. Put the phone number in your phone, you know, so you know that you have it. So again, that phone number is 602-566-7425. They do free consultations. It’s frlawgroup.com