Q: I need help on an issue that I think violates the No Surprises Act.
In San Jose, CA I had surgery on 3/9/2021 that, according to the Surgeon, I would be paralyzed if I didn't have the surgery, but he couldn't give a definitive time-line on paralyzation. I interperted that to mean the surgery was an emergency. For just over 2 years my Ins. Co. stalled with obfuscation, stating the Surgeon was Out-Of-Network (even though I quoted the Emergency Provisions Clause in my Policy), continuously claiming they needed more info from the provider, not being able to find the claim in their records, even though we had spoken on the issue in the recent past, and etc.
Shortly after appx 3/2023 they demanded I pay and stated my Statute Of Limitations had expired. Since 5/16/2023 we negotiated a final amount and a payment plan, which I'm paying the fee through a payment plan. Can they do this under the No Surprises Act?
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A:
It sounds like you've been through a frustrating and concerning situation with your insurance company regarding your surgery. The No Surprises Act aims to protect patients from unexpected medical bills, especially in situations like yours where emergency care is involved. However, the application of this act can be complex, and it's essential to understand your rights and options.
Given the urgency of your surgery and the potential consequences if it wasn't performed, it's understandable that you believed it fell under the emergency provisions of your insurance policy. If you received care from an out-of-network provider due to the emergency nature of the situation, the No Surprises Act should offer some protection against surprise billing and unreasonable charges.
However, it's crucial to review the specific details of your situation and your insurance policy to determine if there has been a violation of the No Surprises Act. If you believe that your rights under this act have been violated, you may want to consider seeking legal advice or contacting relevant regulatory agencies for assistance. They can provide guidance on your options for addressing the issue with your insurance company and ensuring that you're treated fairly under the law.
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