Surprised medical bills were supposed to belong to the past. Surprise – This is not the case.

Last year, in Massachusetts, after finding lumps in her chest, Jessica Chen went to the campus of the General Hospital of Lowell-Saints, which is part of Medicine toft, for a mammography and an ultrasound. Before the projections, she asked the hospital for the patient’s estimated responsibility for the bill using his insurance health plan. Her portion, it was said, would be $ 359-and she paid him. She was more than a surprise for weeks later to receive an invoice asking her to pay an additional $ 1,677.51. “I was already trying to establish $ 359, and it was several times higher,” said Chen, medical assistant.

The law on surprises, which entered into force in 2022, was rightly announced as historical legislation, which “protects people covered by group and individual health plans to receive surprise medical invoices”, according to the Centers for Medicare & Medicaid Services. And yet, the invoices that take patients like Chen by surprise continue to come.

With the help of her software boyfriend, she found the complex price list “readable by machine” that hospitals are required to publish online and sought the negotiated rate between Lowell General and her insurer. It was $ 302.56 – less than she had paid.

CMS is accused of applying the law, then Chen sent a complaint concerning the surprising bill to the agency. She received a laconic email in return: “We have examined your complaint and determined that the rights and protections of the surprises law do not apply.”

When I asked the health system to explain how a surprisingly out-of-esteem bill could be generated, the spokesperson for Toft Medicine, Jeremy Lechan, replied by e-mail: “The invoicing of health care is complex and includes various factors and data points, so that real care costs provided can delay initial estimates. We understand the frustration that these entertainment can cause. ”

Here is the problem: although the No Surprise law was a phenomenal success to ensure unfair practices in the Far West of medical invoicing, it was hardly a panacea.

In fact, the measure protected patients mainly from a single type of particularly blatant surprise bill who had become more and more common before the promulgation of the law: when patients unconsciously obtained out -of -network care in a network establishment, or when they had no choice but to offer out -of -network care in the event of an emergency. In both cases, before President Donald Trump signed the law at the end of his first mandate, patients could be struck with tens or hundreds of thousands of dollars in off -network invoices that their insurance would not pay.

The law on surprises has also provided a certain protection against bills above, but for the moment, protection is only for patients not insured and self-payed, so it would not apply in the case of CHEN because it used health insurance.

But patients who are eligible are generally entitled to an initial estimate and in good faith for treatment, they plan at least three working days in advance or if they ask for one. Patients can contest a bill if it is more than $ 400 compared to the estimate. (The law on surprises also demanded what was equivalent to a good faith estimate of direct costs for patients with insurance, but this provision has not been implemented, because, almost five years later, the government has still not issued rules on the exact form it should take.)

Thus, surprising medical invoices – the invoices that the patient could not have anticipated and never consented – are always amazing of countless Americans.

Jessica Robbins, who works in the development of products in Chicago, was certainly surprised when, unexpectedly, she was recently invoiced $ 3,300 per Endeavour Health for a breast MRI she had received two years earlier, with a prior authorization from her insufficient, Blue Cross and Blue Shield of the Illinois. By trying to solve the problem, she found herself taken in a Kafkaesque circle involving dozens of calls and emails. The clinic where she no longer had the existence of the procedure, having been bought by Endeavour. And she no longer had a blue cross.

“We are actively working with the patient and his insurer to resolve this issue,” said Endeavour spokesperson Allie Burke in an email answer to my questions.

Mary Ann Bonita de Fresno, California, school started this year to become a nursing assistant when, on Friday, she received a positive skin test for tuberculosis. The administration of her school said that she could not go back to class until she had an x -ray with a negative chest. When his permanent Kaiser doctor did not respond to test requests for the test for several days, Bonita went to the emergency room and paid $ 595 in advance for radiography, which has shown no tuberculosis. She and her husband were therefore surprised to receive another invoice, for $ 1,039, a month later, “without explanation of what it was,” said Joel Pickford, Bonita’s husband.

In the above cases, each patient questioned an expensive and unexpected medical accusation which was a shock – only to note that the law on surprises did not apply.

“There are many billing problems that are surprising but which are not technically surprise bills,” said Zack Cooper, an associate professor of economics at the University of Yale. The law on surprises has set a specific type of accusation, he said, “and it’s great. But, of course, we have to address others.”

Cooper’s research has revealed that before the surprise law is adopted, more than 25% of emergency visits have given a surprise bill outside the network.

Official CMS of the Alification Alification has received tens of thousands of complaints, which he investigates, said Catherine Howden, spokesperson for the CMS. “Although certain billing practices, such as delayed invoices, are not currently regulated” by the surprise law, said Howden, complaints of complaints nevertheless help “clarify the potential areas for future improvements”. And they are necessary.

Michelle RODIO, teacher in Lakewood, Ohio, had a persistent cough of weeks after pneumonia which required treatment with an antibiotic course. She went to the Lakewood Family Health Center in Cleveland Clinic for an exam. His x -ray was fine. Just like his nasal stamp – with the exception of the superb $ 2,700 bill he generated.

“I said:” It’s a surprise bill! ” “, Roadi recalls at the supplier’s finance office. The agent said that was not the case.

“So I said:” Next time, I will be sure to ask the doctor an estimate when I have a nose swab. “”

“Doctors cannot know,” replied the agent, as Rodio recalled – and in fact, doctors generally have no idea of the cost of the tests they order. And in any case, Rodio was not legally entitled to a binding estimate, because the part of the law on surprises which grants patients with insurance which has not yet been implemented.

She was therefore stuck with an invoice of $ 471 (the responsibility of the patients of the costs of $ 2,700) to which she could not have consented (or reject) in advance. It was surprising – shocking for her, even – but not a “surprise bill”, according to the current law. But should it not be?