No More Surprise Emergency Bills for Nevadans Under AB469

The year 2020 has arrived, and Nevada rang in the new decade with a set of more than 70 new laws that will take effect in the first week of January. These laws include some major changes for health care — one of the most notable being the ban on surprise emergency room bills.

After almost a decade of deliberating and finessing the language of AB469, the government finally put this legislation into effect, laying out the process by which emergency medical providers and hospitals will be reimbursed by insurers for the emergency services rendered to out-of-network patients. This article will overview the positive changes that Nevadans will see under this law and what it means for emergency health care moving forward.

The Problem With Surprise Emergency Billing

For many years, emergency room bills have been a huge problem for Nevadans. Karen Pollitz, a senior fellow at Kaiser Family Foundation, told a local news source that surprise emergency billing happens more often than most people realize. Even insured people sometimes need procedures that aren’t covered by their plan.

She described some examples, including one of a woman in labor who went to an in-network doctor and hospital only to receive an epidural from a doctor who wasn’t in her network. This woman later received a separate bill for that service because it wasn’t performed by an in-network provider. In another scenario, a man got a life-saving operation at an in-network hospital, but the operation site later became infected. He returned to the same in-network hospital for treatment, but because an out-of-network doctor treated his infection, he was billed directly for the services.

Ending the Financial Plague on Nevada Families

In a medical emergency, minutes can mean the difference between life and death. That’s why, in such a situation, the last thing on anyone’s mind is traveling out of their way to find a hospital in their insurance network — and certainly, no one would ever think to deny immediate emergency medical help from an out-of-network professional. Nobody should be worried about money when a life is on the line, nor should anyone be penalized for seeking medical attention from the nearest provider.

Nevade Governor, Steve Sisolak, agreed by saying “No Nevadan should have to worry about getting hit with an unexpected five-figure medical bill for receiving emergency care that their life could depend on … We’re taking an important step to make health care more affordable and to address an issue that has plagued Nevada families for far too long. That stops today.”

An Important Step Toward Affordable Health Care for Nevadans

Governor Sisolak stated with optimism that this bill was a key step toward affordable health care in Nevada. The new legislation will ensure that, after providing medically necessary services, health providers may no longer send patients a sky-high balance bill listing the expenses that weren’t covered by their out-of-network insurer.

Instead, the patient only pays the insurance copay or deductible established by their insurance plan. Whatever balance remains will be hashed out between medical providers and insurance companies, and the patient will no longer be stuck in the middle. The law also enacted requirements for emergency providers to transfer patients to a hospital within their network within 24 hours after they have stabilized.

In sum, AB469:

• Places a limit on what a medical provider can charge an out-of-network patient for medically necessary emergency care
• Requires out-of-network providers to transfer patients to in-network facilities within one day of a patient reaching a stable condition
• Predetermines the way providers calculate how much an insurer will pay for medically necessary out-of-network services
• Requires thorough documentation and reporting throughout the process

Key Concepts to Understand About This Legislation

If you are a Nevada citizen that regularly uses the state health care system, it’s important to understand the definition of “medically necessary” when seeking emergency help from an out-of-network provider. Under AB469, medically necessary emergency services are defined as, “Health care services that are provided by a provider of health care to screen and to stabilize a covered person after the sudden onset of a medical condition that manifests itself by symptoms of such sufficient severity that a prudent person would believe that the absence of immediate medical attention could result in:

1. Serious jeopardy to the health of the covered person
2. Serious jeopardy to the health of an unborn child of the covered person
3. Serious impairment of a bodily function of the covered person; or
4. Serious dysfunction of any bodily organ or part of the covered person.”

Under the law, Nevada hospitals must provide emergency care to patients regardless of their financial circumstances. But if your medical needs are not immediate or life-threatening, it would be in your best interest to seek out an in-network provider to avoid being stuck with astronomical bills from uncovered expenses.

Rely on a Personal Injury Lawyer After an Accident

To read more about AB469, you can read the legislation directly here. If you or a loved one has been critically injured by another’s negligence and required emergency medical services as a result, contact Shook & Stone. We’ll fight for your rights as a victim and make sure you get compensated for any in- or out-of-network emergency care costs you had to pay.