Unsurprisingly, I am writing about the No Surprises Act (NSA) today. Last year, I had quite an unwelcome surprise. I was thrown from my horse on Feb. 20, 2022. I’ve been thrown from many horses, and usually I land on my boots, or, at worst, my behind. However, last year, I awoke in the ICU. Surprise!
Spoiler alert, I ended up okay, according to most. However, I was helicoptered from the extremely rural area to the closest hospital. And you are probably thinking I was blessed that someone could contact and obtain a helicopter so quickly for me…it probably saved my life. And you may be right. But there are two things about me you probably don’t know: a) my best friend in life is an ER trauma nurse with over 20 years’ experience; and b) I don’t like to spend $49,753 for a helicopter ride that I don’t even remember.
Let me explain. As I said earlier, I was unconscious when someone contacted a helicopter. Let me tell you who I was with – to set the stage, so to speak. I was with my husband Scott, my BFF Tracey (the ER trauma nurse), and her husband Josh. Quite frankly, I didn’t think to ask who called the helicopter until now. Regardless, I was helicoptered and received a bill a month or so later for almost $50,000. And I freaked.
I am without a doubt even more sympathetic to my provider-clients who get notices of owing tens of thousands or millions of dollars. That $50,000 stopped my heart for a second. Then, I thought, Dr. Ronald Hirsch and others have spoken about the NSA multiple times on Monitor Mondays. Maybe I should re-listen to a couple of really good, detailed podcast episodes. So I did so.
Last year, in my unconscious state, I would have entrusted my life with Tracey to drive me about 30 minutes to a hospital, because, as noted, she is an ER trauma nurse. She is good at her job. She was handed a decapitated arm once. I am sure I would have had nightmares, but not she.
She also works at the nearest hospital, and it was only 30 minutes away. She is friends with the ER surgeons. So, yes, had you asked me whether I wanted a $50,000 helicopter ride or a 30-minute car ride with an experienced ER trauma nurse – I would have chosen the free one. From some of her stories, I think she may be more experienced than some of the MDs she performs under.
However, after I presented this story on RACmonitor, Dr. Hirsch, along with several listeners, one of whom is an emergency physician, told me that they would NEVER recommend a private transfer to the hospital, even if Dr. Hirsch were driving, especially for an unconscious head-injury victim.
I was told that the helicopter was the way to go, in my case, but that I should not be financially liable for it. I agree, hence the NSA. However, in the same vein, providers need to be paid. Remember, this paragraph was written after this RACmonitor episode, and after I was told that the helicopter was the way to go.
However, had you asked me then, I would have chosen the free ride to the hospital. Post haste!!! But I was “forced” to the helicopter. And here is where the NSA gets confusing. It became effective in January 2022. A month or so after my accident, I got the bill. Like I said, my heart palpitated – just like the doctors, hospitals, DME providers, dentists, LTCF, HH, BHP, and anyone who accepts Medicare or Medicaid hearts’ would palpitate when they receive a bill for tens of millions of dollars that they may or may not truly owe.
The date of service happened to be one month after the NSA went into effect. No one wanted to pay for this ride. My health insurance went to bat for me (or, really, for them). My health insurance also didn’t want to pay for my $50,000 helicopter ride. The letter from my insurance company to the helicopter company said: “Upon review of your request, we have confirmed the claim was processed according to the terms of the No Surprises Act. Accordingly, your request does not qualify as an appeal under the terms of the member benefit plan.”
While I agree that I should not have been liable for a $50,000 helicopter ride, I do have empathy for the helicopter company and its nurses. It expended money on my behalf. And I am appreciative. I feel like there should be a less draconian law than the NSA. Because of my being unconscious during my helicopter admission and my lack of ability to consent, it shouldn’t mean that the providers shouldn’t be paid for services rendered.
But maybe the letter, which ostensibly shuts down any appeal to additional funds by the provider, means that the provider was paid an amount – maybe a reduced amount, but an amount, nonetheless. If anyone knows whether surprised patients’ medical bills get paid at a reduced rate, let me know! Thanks!
When Medicare introduced the Prospective Payment System (PPS) in the 1980s, it was billed as a revolution. Hospitals would be paid the same flat amount
There are times when the Centers for Medicare & Medicaid Services (CMS) doesn’t agree with itself. I am dealing with a situation in which one
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