‘I got scammed’: Americans describe getting surprise medical bills via health care loopholes

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“It feels a little bit like a bait and switch, and that’s not on the doctors,” Paul Shafer, assistant professor at Boston University School of Public Health said.

that it was also unconstitutional for the ACA to require insurers to cover preventive services without copayments.that they would not be willing to pay for a majority of the preventive services covered by the ACA mandate.

Essentially, insurance companies grow by taking market share from each other, and Potter and other industry experts refer to this as “churn.” The No Surprises Act, which became law in 2021, was intended to prevent patients from receiving surprise medical bills. However, it also comes with another loophole: The law protects patients receiving care from out-of-network providers and out-of-network emergency services, but it doesn't apply in circumstances where the care is being provided by in-network providers, regardless of whether or not it should be free for the patient.

In one of the forms, an individual was told that if they discussed any new or chronic medical issues with their doctor, their insurance would be billed for both an office visit and a preventive health exam.

 

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I worked in hospital IT as a multi-system programmer. Because of Y2K we had to move to a new software platform. Our Forth language system was hard coded & not database driven but it was from the OS, up. The new system would produce any insurance claim as long as it was 'setup'.

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