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What to Do If You Get One

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Share on PinterestThe No Surprises Act, which protects privately insured patients from unexpected medical bills, comes into force on January 1st. Drazen / Getty Images

  • On January 1, 2022, Americans will be protected from surprise medical bills under the No Surprises Act.
  • Surprising medical bills arise when a patient visits a provider outside the network through no fault of their own.
  • Insurers and providers negotiate remaining bills and effectively keep patients out of the way.

On January 1, 2022, a new law will come into effect that will end surprise medical bills for policyholders receiving emergency medical care and other health services in the United States.

Last December, Congress, with bipartisan support, passed the No Surprises Act, which introduced new federal safeguards against surprise medical bills.

But what types of medical bills are covered by the law, how does it protect consumers, and will it affect overall health care costs and premiums?

Healthline spoke to two health policy experts to clarify these questions.

The No Surprises Act defines surprise medicine in a specific context.

“This is important because there are numerous situations that can be surprising but don’t fall into that official bucket of surprising medical bills,” said Jack Hoadley, PhD, research professor emeritus at the Health Policy Institute of the McCourt School of Public Policy at Georgetown University.

These situations may include not knowing that your health insurance plan has a high deductible or that a particular procedure will cost that much.

While such bills can certainly come as a surprise, they don’t fall under the No Surprises Act.

“When we talk about surprise medical bills for the purposes of the No Surprises Act, it means situations where you are generally using an off-network healthcare facility or provider through no fault of your own,” said Hoadley.

This occurs most often in emergency situations.

For example, if an ambulance takes you to an off-network hospital, you may receive a costly surprise invoice for the services provided.

“You didn’t choose that,” said Hoadley. “You have come to every hospital you have been taken to.”

Even in hospitals that are part of the network of your insurance company, there are situations in which the attending physician is outside the network. This can be done during an urgency or electoral procedure.

“So even if you’ve done your due diligence and selected a facility on the network and selected a surgeon on the network for your procedure or an obstetrician on the network for the birth of your baby, you can still be there from an off-network anesthetist, radiologist or cardiologist be treated, ”said Hoadley. “And again, it’s not something that has been told about or that can be controlled.”

Often times, the result of these scenarios is a surprise bill asking people to pay the “balance bill,” or the difference between what the insurance company paid and the total amount.

Research has shown that 1 out of 5 cases in the inpatient emergency room can lead to surprising medical bills.

Studies show surprise medical bills average more than $ 1,200 for anesthesia, $ 2,600 for surgical assistants, and $ 750 for births.

The law to avoid surprises ensures that privately insured patients do not pay more than the network-internal tariff if they are treated in external facilities or by external health professionals without their consent.

“January 1st will protect patients in emergency, non-elective emergencies, and ambulances from unexpected medical bills,” said Christopher Garmon, PhD, assistant professor of health administration at the University of Missouri-Kansas City’s Henry W. Bloch School of Management.

Currently, the law does not apply to ground ambulances, but it has created an advisory committee to develop recommendations on fee disclosure, protection from surprise billing, and enforcement mechanisms.

People can still choose to seek treatment from healthcare professionals and institutions outside the network for electoral processes, but the new law requires them to be given advance notice and consent.

The No Surprises Act also sets out a procedure for handling balance bills between providers and insurers.

The two will negotiate prices and if a solution cannot be found an independent arbitrator will be called in to determine a fair refund.

“It is important that the patient is completely taken out of the middle,” said Garmon.

In September, a new ruling by the Biden administration, which provides more detailed information on settling bills for off-grid balances under the No Surprises Act, drew a lot of criticism, especially from doctors and hospital groups.

According to the rule, when a dispute comes before arbitration, the arbitrator must assume that the qualifying payment amount (defined as the median intra-network price for similar services provided in an area) is reasonable to pay off-network maintenance.

Other factors can also be taken into account, e.g. However, other factors such as the experience of the healthcare professional, the type of hospital and the complexity of the care are not weighted equally.

Several health-care organizations, including the American Hospital Association and the American Medical Association, have filed lawsuits found that this rule gives insurers an unfair advantage.

Some have also raised concerns that the No Surprises Act will lead to an increase in health premiums.

Garmon said he didn’t think this was likely. In fact, the Congressional Budget Office estimates that the No Surprises Act should reduce premium growth by 0.5 to 1 percent in most years.

“I think that’s a good, reasonable estimate,” said Garmon.

Hoadley said it could go either way depending on how negotiations on the network go in the future.

“For example, if an insurance company is negotiating with a group of anesthesiologists the amount of their fees in the insurance plan for the doctors on the network, this new set of rules will cast some shadow over those negotiations,” he said. “It could result in lower rates that would actually help with the premiums, or it could result in higher rates that could increase the premiums.”

However, he doesn’t expect the impact to be that great.

“We’re probably talking about a 1 percentage point swing one way or the other,” he said.

While the No Surprises Act is designed to stop surprising medical bills from being issued to patients, there are a few steps you can take to correct this if you receive one after January 1.

“We assume that there will be some of these situations,” said Hoadley. “It can take time for insurers, providers and institutions to understand the new rules and get them right.”

The first step, Hoadley recommends, is to contact your health insurance company.

“When you get your declaration of performance, they’ll tell you how much you have to pay and how much the policy pays, and then you can compare that to the bill you received from the medical facility and see if you’re” yours being billed more than you should, ”he said.

Finally, under the new law, a Department of Health complaint line and website will be set up for anyone who believes they have been mistakenly issued a surprise medical bill.

The toll-free number for the No Surprises Help Desk is 800-985-3059. The line goes live on January 1st.

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Men’s Health

Homeless and rehousing centers in Bloomington concerned with rising COVID-19 numbers

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Local nonprofits dedicated to helping the homeless and those living in extreme poverty hope to share their resources and willingness to serve the community despite the surge in COVID-19 cases in Bloomington.

Beacon Inc. is one such non-profit organization that can provide housing and other essential services such as meal and laundry services and access to caseworkers.

Since the pandemic began, Beacon Inc. executive director Rev. Forrest Gilmore said his staff have adjusted protocols and encouraged customers at the Shalom Center and Friend’s Place to get vaccinated and get the booster shot.

With fewer resources related to COVID-19 than last year, Gilmore said staff cuts caused other problems enforcing safety measures like temperature checks at the door.

“We saw a really big eruption a year ago,” Gilmore said. “We had alternative accommodation for people to isolate and/or quarantine, but we don’t have that this year.”

Related: [Omicron surge pushes Monroe County into the county advisory red zone]

He said the shelter is fortunate to report that not a single person has been made homeless by COVID-19 since the pandemic began.

Gilmore said winter also poses greater challenges and threats for those sleeping outside, particularly in colder and wetter conditions.

“Our program doesn’t necessarily change with the weather,” Gilmore said. “We always want people to be home and realize there’s a greater urgency and try to get people the things they need to be safe.”

Wheeler Mission is another community service organization that provides accessible housing and other essential goods and services to homeless, poor and vulnerable members of the community, said Dana Jones, director of Wheeler Mission.

“As the CDC has indicated, we have to learn to live with this in the future,” Jones said.

Jones said before the pandemic, the men’s facility was regularly operating at near capacity. The Wheeler Mission could accommodate a total of 130 men, but since the pandemic, the Wheeler Mission can only accommodate 117. He said staff are following Centers of Disease Control & Prevention protocols and are reducing maximum capacity. Wheeler Mission used to be able to provide 40 beds in the women’s shelter, today there are only up to 35 women.

“We have done much to provide care and comfort to the populations we serve during the pandemic,” Jones said.

Related: [New Hope for Families looks to provide homeless families with donations during holidays]

Jones said his staff are monitoring people as best they can and isolating them at the shelter if necessary.

New Hope for Families is an agency that supports and empowers families affected by homelessness.

“Homelessness looks different for different families,” said Emily Pike, executive director of New Hope for Families. “Families are often afraid to seek help because being homeless with your children is an act of abuse or neglect.”

Pike said she and her staff were working their hardest to prevent families from sleeping outside. New Hope has two buildings: one with four bedrooms and the other with three bedrooms. She said for families with critical needs, staff find motels and provide them with overnight services.

Pike said since the pandemic, New Hope has made sure families have been able to isolate in the shelters. New Hope also strongly encourages customers to get vaccinated and boosted. She said IU Health will be running a refresher clinic next week for those who wish.

Pike said she appreciates the help of the Monroe County Health Department and local clinics to ensure resources are available to the entire community and not just those with financial stability.

“An agency like New Hope couldn’t exist just anywhere; There’s a reason so many family shelters have a work requirement, a marriage requirement, and a faith requirement,” Pike said. “That’s because this reflects the values ​​of those communities, and I’m really proud that our community’s values ​​are that everyone deserves a safe place to sleep.”

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Men’s Health

Limitless X Founder and CEO Jas Mathur Teams Up With HealthCorps for Partnership to Empower Youth

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Entrepreneur and Limitless X founder and CEO Jas Mathur announced this week that he is teaming up with a non-profit organization HealthCorps to launch health and wellness programs aimed at teens and young adults.

As part of that announcement, Mathur spoke to Dr. Mehmet Oz, Founder and Chairman Emeritus of HealthCorps, to reflect on his own personal health journey, which is one of the reasons he was so interested in a partnership HealthCorps. As a young adult, Mathur sacrificed his personal health and at one point weighed 450 pounds. After turning his health around, he began running several health and wellness companies and became a sought-after fitness professional. During this process, he also built a massive platform with seven million Instagram followers.

During their discussion, Dr. Oz Mathur for his “boundless” journey.

“You recognized the challenges, you overcame them, and you continued to broaden your horizons,” he said. “What is often limitless is looking at the horizon, at the prospect of the possibilities out there. It really is limitless when you see the world like that.”

In telling his story, Mathur noted that he had to completely rethink his life and attitude to get there.

“I basically reinvented myself by reinventing the way I think.”

HealthCorps

As a result of this transformation, he has become a successful investor and entrepreneur who has developed various brands in the marketing, health and wellness industries. As a teenager, Mathur specialized in internet advertising and website building. Now, Mathur’s marketing and branding company, Limitless, is responsible for launching premium dietary supplements and CBD supplement products.

Mathur’s wellness journey has helped him become a leader in the healthcare industry in return for the chance to work with him HealthCorps. The nonprofit organization works to save lives through health-based education leadership, programming, and service-learning in vulnerable communities. Her initiatives are launched both inside and outside of school to help teenagers improve their health.

“I’m happy about the support HealthCorps as they help others who are stuck in bad health choices or don’t have access to good nutrition or exercise programs to get the same opportunity,” Mathur said.

Mathur has also become an expert in developing fitness and exercise programs and has helped celebrities on their own personal health journeys. So join forces with HealthCorps sharing his expertise was a breeze. Sharing the story of his reinvention as the health and wellness pro of a teenage tech mogul, Jas explained why he is committed to HealthCorps’ mission and why he looks forward to working with them on important initiatives.

HealthCorps helps young people achieve their goals and dreams,” said Mathur. “I feel like I’ve done that in my life, and I want to help them accomplish the same thing in their own personal health journey.”

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Men’s Health

World’s Strongest Man Brian Shaw’s High-Volume Strongman Workout

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Brian Shaw has big goals for 2022. The former World’s Strongest Man (he won the title in 2011, 2013, 2015 and 2016) will be back in competition this year and his training has already begun. In a new video, he walks his followers through one of his high-volume workouts.

“I feel like I had a lot of momentum at the end of 2021 and I’m going to carry that into 2022,” he says. “Every single day is an opportunity to start. Every single day is an opportunity to get better… I am now building myself to be the strongest man in the world. It’s crazy to say, but we’re literally 20 weeks away, so every single workout, every single week is very, very important.”

Shaw shared that he now works with another strength coach, “Big House” Joe Kenn, who Shaw says is “one of the best, if not the best, strength coaches in the world.” Shaw says he worked with him back in 2005.

To begin the workout, Shaw begins with resistance band warm-ups (4 sets of 25 reps), including: overhead tricep band extensions, band pulls, and a Flex Fitness converging chest press. He takes about 10 minutes.

“It blew my arms out of my shirt,” he says. “I have a good pump running.”

Next, he does a prone dumbbell row (15 reps) with a top set shoulder press (one shoulder press for the first set, followed by a high incline and a lower incline for 5 sets of 15 reps each).

“Massive volume today,” he says.

He arrives and the sweat begins to pour.

“That got right in the middle with all those reps. That’s a lot of volume,” he says. “But the elevator press is an interesting movement because the overhead press is probably the hardest, and then it gets a little bit easier, a little bit easier as you get more and more tired. The rowing definitely caught up a bit faster than I thought they were going to do today. But the presses worked really well, I think. That was a hell of a challenge.”

The last thing he has is a medley including: one-arm cable lateral raises, one-arm standing overhead press with dumbbells, a seated one-arm shrug, one-arm overhead rope tricep extension, and one-arm dumbbell curl. He will do 15 reps for each exercise for 4 sets.

He gets there and works his way through all four sets.

“Man, I feel good. But I will definitely say that ‘Big House’ Joe Kenn is definitely putting me through my paces right now, and this volume definitely kicked my butt a little bit. I’m not used to it. It’s taken me a bit out of my comfort zone here,” admits Shaw. “But sometimes, if you want to get better, you have to step out of your comfort zone. And if you want something bad enough, you have to be willing to work for it. If I put that amount of work into the next 20 weeks on my way to becoming the world’s strongest man, it’s going to be something very, very good and something I’m proud of.”


Emily Shiffer is a former men’s health and prevention digital web producer and is currently a freelance writer specializing in health, weight loss and fitness.

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