Thank you for choosing Albuquerque ER & Hospital for your emergency medical care. To better serve you, we want to make the billing process simple and transparent. We understand that some patients may find the billing process confusing or overwhelming. We want to help you understand your bill. Your bill may be different from other medical bills you may have received from hospitals or physicians. It’s important to note that Albuquerque ER & Hospital is an emergency center and hospital.
In an effort to protect patients, the federal government issued the Federal No Surprises Act (NSA). The NSA addresses several different points. The most notable point is the NSA serves to prohibit surprise billing. A surprise medical bill is an unexpected bill, often for services received from a healthcare provider or facility, that a patient may not have known was out-of-network with their insurance until a bill is received. Simply stated, an out-of-network provider cannot send a bill to a patient for any amount outside of their yearly in-network deductible and co-insurance. This does not apply to amounts paid directly to patients by their insurance provider for services rendered rather than paid to the provider. In those cases, a patient may receive a bill for full charges until the insurance payment amount is provided or paid over to the appropriate facility by the patient.
The Federal No Surprises Act was issued after lawmakers passed a law to base emergency services payments on local median in-network rates, also known as QPAs, instead of usual and customary rates. The law enacted a system where insurers and providers negotiate the correct amount to be paid. Once in agreement, the bill can be settled through an independent dispute resolution process. Insurers must now disclose how they come to the QPA-median in-network price and if they down-coded the claim for any reason.