Migliaccio & Rathod LLP is investigating whether certain employer-sponsored health plans and health insurance administrators have improperly charged patients out-of-network costs and surprise medical bills services that federal law requires to be treated like in-network care.
The federal No Surprises Act protects patients in many situations where they unexpectedly receive treatment from an out-of-network provider. For example, a patient may go to an in-network hospital but unknowingly receive treatment from an out-of-network anesthesiologist, radiologist, pathologist, emergency-room physician, or other provider. Similar protections generally apply to emergency care and certain air-ambulance services.
In these situations, patients generally should not be required to pay higher out-of-network cost-sharing simply because the provider was outside their network. In addition, the patient’s required payment generally must count toward the patient’s in-network deductible and in-network out-of-pocket maximum.
We are investigating whether some health plans and claims administrators have incorrectly processed these claims as out-of-network, causing patients to pay too much or preventing their payments from counting toward their in-network deductible or out-of-pocket maximum.
You May Be Affected If:
- You receive health insurance through your private-sector employer, or through a spouse’s or parent’s private-sector employer;
- Since January 1, 2022, you received emergency treatment, air-ambulance services, or treatment at an in-network hospital or surgical facility;
- One of the doctors or other providers involved in your treatment was out-of-network;
- Your Explanation of Benefits (EOB) shows that you were charged an out-of-network deductible, coinsurance, or copayment;
- Your EOB or insurance portal shows that some or all of what you paid was applied to an out-of-network deductible or out-of-pocket maximum instead of your in-network totals; or
- You received a substantial bill because your health plan treated one of these services as out-of-network.
You may qualify even if your health plan normally provides little or no out-of-network coverage.
Does This Apply to Your Health Plan?
This investigation generally concerns people who receive health insurance through a private-sector employer, or through a spouse’s or parent’s private-sector employer. Both self-funded employer plans and plans purchased from an insurance company may qualify.
Government employee plans and certain church plans generally are not governed by ERISA.
If you are unsure whether your plan qualifies, you do not need to figure that out yourself. Documents such as your insurance card, Explanation of Benefits, Summary Plan Description, or employer benefits materials may allow us to determine whether your plan is covered.
We Are Interested in Hearing From Patients Who:
- were treated at an in-network hospital but received a bill from an out-of-network doctor;
- were charged out-of-network rates for emergency care;
- had an out-of-network anesthesiologist, radiologist, pathologist, emergency physician, or similar provider involved in their care;
- saw payments credited to the wrong deductible or out-of-pocket maximum;
- continued paying medical bills after believing they had already reached their in-network out-of-pocket maximum; or
- have EOBs, bills, or insurance portal screenshots showing these problems.
If you believe your employer-sponsored health plan improperly issued surprise medical bills, we would like to hear from you. Please complete the contact form on this page, send us an email at [email protected], or call us at (202) 470-3520.