Nashville woman warns about estimate loophole in No Surprises Act

NASHVILLE, Tenn. (WSMV) - A Nashville woman said she was caught off guard by her medical bill, and it points to a loophole in the federal No Surprises Act.

Michelle Roberts agreed to get steroid injections at Premier Radiology Pain Management Center to try and help her sciatic pain. She was given an estimate of $230, but the bill that arrived at her home was $908.

“I thought I was gonna have another stroke. I really was dumbfounded,” Roberts said.

The federal No Surprises Act went into effect in January 2022 and aims to keep people from receiving unexpected or higher than expected bills.

Braden Pan, the CEO of a patient advocacy company called Resolve, said the No Surprises Act has helped patients, but there are loopholes.

One of those is a waiver requiring people to pay the bill, regardless of whether or not it’s close to the estimate.

“So, people sign the waiver without really thinking about it, and then get billed significantly more,” Pan said.

Roberts did check a box on her estimate with that agreement. However, the No Surprises Act does contain a way to dispute that bill if the final bill is at least $400 above the good faith estimate.

Unfortunately, that’s only for those who are uninsured. Because Roberts is insured, she can’t utilize that resolution process.

Roberts said she’s not trying to get out of paying the bill, but she wouldn’t have agreed to the procedure if she’d known that final cost.

“What’s the point in giving the estimate out if they’re just going to charge who knows how much?” she said.

WSMV4 reached out to Premier Radiology, who offered this statement:

Ultimately, the office did offer Roberts a 25% discount on her bill. Roberts said what hurts even more is that she’s paying for injections that didn’t give her the pain relief she needed.

“The money is going down the drain, you know, and it just didn’t help me,” Roberts said.

Pan said preventing these types of situations can be hard upfront, but there are things you can do on the back end.

Here are some tips he provided:

• Ask about cash pay. Pan said if you have a high deductible you don’t expect to fulfill, you may save money paying cash to the office and not filing through your insurance.
• Get an itemized bill. Pan said to look to make sure they’re charging you for the services you received and there aren’t any duplicate charges.
• Call your insurance. Pan said based on the way something may be coded, insurance may improperly deny claims. Talking with an agent and providing additional documentation may help get a claim approved.
• Apply for aid. Pan said many hospitals have a financial aid program and you should check to see if you qualify.

To read more about what’s covered under the No Surprises Act, click here.

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