Receiving medical care can be stressful enough without the added burden of unexpected medical bills. Unfortunately, surprise medical bills have historically caught many patients off guard, leaving them with significant financial strain.

Minnesotans receive some protection from surprise billing through state and federal laws designed to shield patients from such predicaments.

What Are Surprise Medical Bills?

Surprise medical bills occur when patients unknowingly receive care from an out-of-network provider, often during emergencies or at in-network facilities where specific providers are not part of the patient’s insurance network. These bills can amount to thousands of dollars, leaving patients responsible for significant out-of-pocket costs that they did not anticipate.

Common scenarios for surprise medical bills include:

• Emergency care at an out-of-network hospital.
  
  
• Treatment by out-of-network specialists at an in-network facility.
  
  
• Services like anesthesiology, radiology or lab work performed by out-of-network providers without the patient’s knowledge.

To address these issues, Minnesota has implemented laws that protect patients and promote transparency in medical billing.

Minnesota’s Surprise Billing Protections

Minnesota is at the forefront of addressing surprise billing with regulations designed to safeguard patients from unexpected financial burdens. Key components of the state’s laws include:

• Prohibition of Balance Billing: Balance billing happens when an out-of-network provider charges patients the difference between what the insurer pays and the provider’s total fee. Minnesota law prohibits this practice in specific situations, such as emergency care or when a patient is treated at an in-network facility by an out-of-network provider without prior notice.
  
  
• Emergency Care Protections: Patients requiring emergency medical attention often have little choice in where they receive care or which providers attend to them. Minnesota law ensures that patients are only responsible for their in-network cost-sharing amounts for emergency services, regardless of whether the provider or facility is in-network.
  
  
• Advance Notice and Consent Requirements: Non-emergency services are also covered under Minnesota’s laws. If a patient is scheduled for a procedure at an in-network facility, providers must notify the patient in advance if they are out-of-network. The provider must obtain the patient’s written consent before proceeding with treatment that could result in higher out-of-pocket costs.
  
  
• Arbitration for Disputes: Minnesota has established a dispute resolution process to handle billing disagreements between providers and insurance companies. This approach removes patients from the middle of billing conflicts, so they are not saddled with unexpected costs while the parties negotiate.

How the Federal No Surprises Act Works with Minnesota Law

Minnesota’s laws complement the federal No Surprises Act, which went into effect in January 2022. Together, these regulations provide robust protection for patients, particularly when it comes to:

• Emergency care provided by out-of-network facilities or professionals.
  
  
• Non-emergency services at in-network facilities involving out-of-network providers.
  
  
• Air ambulance services from out-of-network providers (ground ambulance services are not yet covered under the federal law).

What Patients Should Know

While these laws provide significant protection, patients should take proactive steps to safeguard avoid scenarios where they could potentially incur large and unexpected medical bills:

• Verify Provider Networks: Before scheduling procedures, confirm whether all providers involved in your care, including specialists, are in-network. This can often be done by contacting your insurance company or the provider’s office.
  
  
• Request Cost Estimates: Ask for a detailed cost estimate before undergoing non-emergency treatment. Providers and facilities are required to offer transparent pricing information upon request.
  
  
• Review Your Medical Bills: After receiving care, carefully review your medical bills for accuracy. If you notice charges that don’t align with your insurance coverage, contact your insurer or provider immediately to resolve the issue.
  
  
• Know Your Rights: Familiarize yourself with Minnesota’s surprise billing laws and the protections provided by the federal No Surprises Act. Understanding your rights empowers you to challenge any improper charges.

When to Seek Legal Help

Despite these protections, billing disputes can still occur. Patients may encounter issues such as incorrect charges, refusal of insurance companies to cover certain services or providers failing to comply with notice and consent requirements.

It may be in your best interest to consult with an attorney If you believe you’ve been unfairly billed for medical care, or you find yourself embroiled in a medical billing dispute and want assistance or advice.

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A lawyer specializing in healthcare or insurance law can help you:

• Challenge improper charges.
• Negotiate with providers or insurers.
• Represent you in arbitration or litigation, if necessary.

Protect Yourself from Medical Billing Surprises in Minnesota

By staying informed about your rights, taking proactive steps to verify provider networks and reviewing your healthcare bills, you can minimize the risk of surprise charges.

If you’re facing a billing dispute or need legal guidance, connect with a trusted Minnesota lawyer through our referral service. Contact us today through our website or give us a call at (612) 752-6699 to find the legal support you need.