No More Surprise Out-of-Network Medical Bills

By Crystal Baldwin

The Consumer Assistance Program’s (CAP) top consumer complaints of 2021 ranks health/medical concerns fourth among the primary problems reported by Vermont consumers, with issues including billing and charge disputes. While the Consumer Assistance Program provides informal mediation on medical billing disputes involving providers, there are several resources available to consumers to resolve medical billing disputes, particularly if a regulated business, such as an insurance provider is involved. In the medical billing realm, consumers have earned more protections just this January through the Federal No Surprises Act, aka the “No Surprises Act” or the “No Surprise Billing Act.”

The No Surprises Act prevents surprise medical bills and has changed how unanticipated out-of-network bills can be assessed. The intention of the act is to remove the surprise that accompanies receiving large unanticipated bills after receiving health care services. There is a lot to know and there are already a number of resources to help you understand the act and your rights more thoroughly, including information on Centers for Medicare & Medicaid Services and the U.S. Department of Health & Human Services websites. 

The No Surprises Act gives some medical billing control back to the consumer.

No More Surprise Medical Bills: 5 Things To Know about the No Surprises Act Taking Effect in 2022 – From HHS.gov

Key information you should know about this new law:

Who does it cover?

People covered under group and individual health plans.

What does the law provide?

Protection from receiving surprise medical bills for most:

  • Emergency services
  • Non-emergency services from out-of-network providers at in-network facilities
  • Services from out-of-network air ambulance service providers

It…

  • Bans surprise billing in private insurance for most emergency care and some instances of non-emergency care.
No Surprises Statement
No Surprises Statement
  • Requires that uninsured and self-pay patients receive key information, including overviews of anticipated costs and details about their rights.
  • Bans surprise bills for emergency care and requires that cost-sharing for these services–like co-pays—always be based on in-network rates, even when care is received without prior authorization.
  • Bans surprise bills from certain out-of-network providers if you go to an in-network hospital for a procedure; cost sharing for certain additional services during your visit will generally be based on in-network rates.
  • Requires providers and facilities to share with patients easy-to understand notices that explain the applicable billing protections and who patients should contact if they have concerns that a provider or facility has violated the new surprise billing protections.
  • Requires most providers to give a “good faith estimate” of costs before providing non-emergency care for people who do not have health insurance or pay for care on their own.
  • Protects against “Balance Billing” abuse. Balance billing is when a provider bills for the difference between the provider’s charge and the allowed amount.
  • Prohibits a preferred provider from balance billing.
  • Prevents air ambulance services from imposing cost-sharing greater than the in-network cost.

When might the law not apply?

While there are many protections in place, a patient may agree to balance billing for certain non-emergency situations, however this must be disclosed in writing and utilize a specific “Surprise Billing Protection Form.” By signing the form, patients agree to give up their federal consumer protections, agreeing to pay more for out-of-network care.

This notice and consent waiver for balance billing is NOT permitted for:

Code Blue sign in hospital
  • Emergency services
  • Unforeseen urgent medical needs arising when non-emergent care is furnished
  • Items/care related to emergency services
  • Diagnostic services including radiology and lab services
  • Out-of-network provider services when in-network providers cannot provide necessary such service

Surprise bills may continue to be issued by the following facilities:

Newborn and mother
  • Birthing centers
  • Clinics
  • Hospice
  • Addiction treatment facilities
  • Nursing homes
  • Urgent care centers (by circumstance)

What if you receive a surprise bill?

There is an independent dispute resolution process for payment disputes between plans and providers as well as new dispute resolution opportunities for uninsured and self-pay individuals.

For remaining questions about the law, visit: cms.gov/nosurprises

What about medical billing disputes not covered under the law?

For those bills that still are not covered, there are some important resources still available to consumers:

Dispute Resolution ResourceIssue
Centers for Medicare & Medicaid ServicesMedicare billing disputes
ERISAPrivate-sector/work place health benefit insurance plan disputes
Insurance Division of the Vermont Department of Financial RegulationHealth insurance billing dispute
Patient Financial Assistance Program of the provider, such as the program available at UVMMCChallenges paying valid medical bills
State Health Insurance Program (SHIP):Help understanding health insurance, including Medicare and Medicaid
Vermont Health Care Advocate (HCA) HelpLine:
1-800-917-7787  
Assistance obtaining free and lower-cost health coverage. Advice and support in solving medical billing problems, including Medicaid. Assistance deciphering health plan coverage.

As described in CAP’s blog a few years back, Navigating Health Care Can Be Tough, click the blog for even more helpful resources. Contact CAP for assistance resolving provider billing disputes.

SLAM the SCAM: Hang up on government imposters!

By Margaret Tabb and Ana Amo

A National Consumer Protection Week feature. “National Consumer Protection Week (NCPW) is a time to help people understand their consumer rights and avoid frauds and scams” (FTC). 

Government Impersonation scams were the top fraud reported between 2014-2021, with a total reported loss of $442.21 million according to the Federal Trade Commission (FTC). In 2020, with the popularity of the Social Security Imposter scams increasing steadily to date, the Social Security Administration Office of the Inspector General dedicated a day during National Consumer Protection Week as National SLAM the SCAM Day, to remind individuals of how to spot these pesky scam calls. The goal of Slam the Scam is to raise awareness during Consumer Protection Week on prevalent government imposter scams and invite consumers to slam down the phone on these scammers! In honor of SLAM the SCAM Day, the Consumer Assistance Program (CAP) is reminding you to SLAM the SCAM and hang up on government imposters.

Hang up on government imposters! SLAM the SCAM! blog.uvm.edu/cap

Receiving a call from someone claiming to be from the government can be alarming. These calls can be threatening in nature, claiming your personal information or identification was involved in a crime, or money is owed to a federal agency. On the other hand, sometimes these calls are more positive which offer fake opportunities for government grants, entitlements, or benefits. In 2021, the FTC reported a[TM1]  total of 396,302 scam reports relating to government imposters. In Vermont, government and legal authority imposter scams clocked in at the fourth most reported scam last year. This accounts for 9% of the 5,154 scams reported to the Consumer Assistance Program (CAP) in 2021, compared to 41% of the top scams reported to CAP in 2018. While the FTC numbers can be startling, there has been an average 7.3% yearly decrease of reported loss to government imposters, meaning consumers did not provide funds. To continue the declining trend of loss to scams, we need your help. To help reduce these fraudulent attempts, CAP will break down popular government imposter scams to help 1) identify the scam, 2) review what to know about the scam, and 3) provide some tips on how to navigate government impersonation scams.

Hang Up on Government Imposters!

Social Security Number Phishing

Identify It: You may get a call, text, email, or even a direct message on a social media platform from someone claiming to be from the Social Security Administration or Magistrate’s Office. The scammer may claim your Social Security benefits are ending or will be suspended unless funds or personal information about yourself is provided. Sometimes there are even threats of arrest or legal action to be taken against you. They will ask you to pay with gift cards, wire transfers, peer-to-peer payment methods (EX: Zelle, Venmo, PayPal, CashApp, etc.), or mailing cash. We have also seen an increase in requesting cryptocurrency, as these transactions are untraceable.

What to Know: The Social Security Administration  would never call you threatening to cut off benefits or suspend your Social Security number. Instead, these are scammers looking to steal your money and identity by gathering your personal information. The Social Security Administration would never contact you via text message, email, or through social media. The only time Social Security will contact you by phone is if you request a call from them. Otherwise, most if not all correspondence occurs through mail. A legitimate government agency would never request money be sent by wire transfer, gift cards, pay with cryptocurrency, or mailing cash. Ignore these fraudulent attempts, and if the call is a robocall, do not press any buttons. If you need to speak with the Social Security Administration, call your local office using the Social Security Office Locator. You may also report the scam directly to the Social Security Administration Office of the Inspector General.

Medicare/Medicaid Imposter

Identify It: Scammers will call, often from a spoofed caller ID number, and pose as Medicare or Medicaid representatives to gain your personal information and money. CAP finds these scams are most frequent during times of open enrollment. The scammers will state they need your Medicare/Medicaid card number or Social Security number to keep your coverage active and verify medical information. The calls may also claim that coverage is expiring or in need of renewal. Scammers will also ask if you received a “new Medicare card”, often referred to as a “gold card” or “red, white, and blue card”. They may claim to be offering sought-after medical supplies or test kits in exchange for your ID.

What to Know: Never provide your Medicare number or other personal information and payment to unknown callers. In general, Medicare cards do not expire. Medicaid, on the other hand, provides coverage for a year with the option to renew yearly. This is done through Vermont Health Connect or Department of Vermont Health Access through the Agency of Human Services. Unless you have called Medicare using the 800 number on the back of your card and requested a callback, Medicare will not call you. If a phone call is required, you would receive a letter from Medicare to schedule a call. Medicare representatives will never call you to verify your information, sell you products, tell you that your coverage is expiring, or to issue you a new card.  In Vermont, representatives of the State Health Insurance Assistance Program (SHIP) at 1-800-642-5119 through local Area Agencies on Aging can help address Medicare questions. Other questions and concerns about Medicare coverage can be directed to Medicare at 1-800-MEDICARE.

IRS Impersonator

Identify It: The scammers will call claiming that they are from the IRS and that you owe them for back taxes. Sometimes the call will begin with a robocall asking you to press a number or to confirm your personal information. They will ask you to pay immediately, and the caller might threaten you to say that the local police will arrest you, legal action will be taken, or your tax documentation will be suspended if you don’t pay. They could even provide some legitimate information like your Social Security number to make you believe that they are related to the IRS, but they are using this call to gain money and more information from you. The scammer usually requests the payment in a specific way, such as wire transfers, access to bank accounts, gift cards, mailed cash, or cryptocurrency.

What to Know: If the IRS contacts you, it would be by mail, not by phone unless you requested a callback. They may call you only after sending you two letters by mail. The IRS will never ask you to pay debts by phone, nor demand a particular payment method. Lastly, legitimate IRS employees will never threaten you. If you didn’t receive written notification about a tax issue and receive a call claiming to be from the IRS, don’t engage. Do not press any numbers, give personal information, or provide funds. This could lead to more scam calls. In this situation, the better thing to do is hang up the phone.

Legal Authority (Police/Sheriff/Litigant/Immigration)

Identify it: The scammer will pose as a police officer, an attorney, or any person with legal authority. They will mention pending lawsuits or government debts involving you and will threaten arrest or legal action. The solution provided by the scammer is to send money, and your problem will disappear. But they will call again, saying that something went wrong, often requesting more money. Variations of this scam can involve immigration issues and the scammer using your legal status in the U.S. to threaten you with deportation and visa revocation.

What to Know: Law enforcement agents, like police officers, sheriffs, or other government employees, will not warn you ahead of time about pending warrants. If you were going to be sued, the papers would be served without notice. The government will never call and threaten you. The best thing to do is hang up the phone and call the legitimate agency’s phone number to check about possible lawsuits, immigration status, and debts. If you are concerned about your immigration application, petition, or status, contact the United States Citizenship and Immigration Services directly.

More Government Impersonation Scams

United States Postal Service (USPS)

Identify It: You may receive a call, email, or most commonly a text from a number you do not recognize, with a “tracking link” for a package or a notice a package was unable to be delivered by USPS. Scammers may also claim to be from U.S. Customs and Border Protection (CBP) regarding a package containing illicit items. In the communication, there may be a number to call or a link to view the tracking information. Once connected with the scammers, you are prompted to pay a fine to avoid arrest or legal action. You may also be prompted to provide additional personal information about yourself to ensure the package can be delivered. In terms of employment opportunities at USPS, please be aware of where the job is being posted and what the scammers are asking for. Offers are created to be enticing by alleging outlandish benefits, guaranteed jobs, or claim they will hire you on the spot.

What to Know: If you are not opted in for text communications from USPS or receive a text from a number not associated with USPS, this is a scam. Additionally, if you were not planning on receiving a package, chances are it is not legitimate. If you receive a package that you did not order, mark it “return to sender” and bring the package to your local mail carrier. If you are questioning if the claimed delivery is real, call your local USPS office to confirm if a package exists. If you are given a tracking number, you can check the legitimacy by using USPS’s Tracking page. U.S. Customs and Boarder Protection posted a press release a few months ago, warning consumers about this scam as well.

Government Funds (grants and unclaimed funds)

Identify It: These types of imposter scams focus on a variation of “free money” scams while pretending to be calling from a government agency. CAP receives the occasional notice about a scam call that claims to be from the State Treasurer, claiming there is “Unclaimed Property” for the individual to claim. Unclaimed Property is any lost or abandoned money that someone has not claimed, usually from past business dealings such as refunds and rebates, an overpayment on an account, or funds that were unclaimed in a financial account that was closed. In order to release those funds, the scammer will ask a fee to be paid, generally claiming the money is for tax purposes or interest on the funds. CAP has also received reports regarding the “Community Development Block Grant” or other government grants, where individuals have received texts and social media messages from fake profiles pretending to be a government employee. You are prompted to provide personal information and told you must pay a fee to receive your grant money. 

What to Know: You would never have to pay money to claim your “Unclaimed Property” through the Office of the State Treasurer. You do not have to pay a fee to claim your Unclaimed Property. You may file for your Unclaimed Property online or by mail with the Office of the State Treasurer. To find out more about unclaimed property, go to USA.gov. The government does not contact you about available grants, you contact them. Legitimate grants require an application and are to be used for specific purposes.  In addition, if you did apply for a grant, you do not need to pay money to receive the grant. You may find available federal grants at grants.gov.

How to Navigate Government Impersonation Scams: 

If you suspect that you are being targeted by a scam, the best thing you can do is not respond. If you receive a scam call, SLAM the SCAM by hanging up! Do not call back the number. If you get an email, text message, or social media direct message, do not engage and mark the correspondence as “Junk/Spam” or delete the message. NEVER give out any personal information, money, or allow access to your devices to someone claiming to be from the government. If you are worried the claims may be true, contact the department directly using a trusted number. If you cannot find one, call CAP to inquire about legitimate contact information. Report scam encounters to CAP. Please see below for information on how to report scams to our office.

Do not trust caller ID. Instead, vet your calls by listening to your voicemail messages. Scammers are known to “spoof” legitimate phone numbers and names of government agencies, using fake identification of government and law enforcement agencies. These scammers can use aggressive tones or create a sense of urgency to provide the information or funds they are requesting. Often, the scammers will say not to tell anyone you spoke with them and to keep your conversation a secret. Do not isolate. Tell a trusted friend, family member, or member of your community to help you navigate this situation. CAP cares and is here to talk with you about the scam call you received.

For more information about government imposter scams, please check out the FTC’s article on How to Avoid a Government Impersonator Scam.

Reporting Scams to CAP

To report scams, please visit our scam reporting form: https://ago.vermont.gov/cap/stopping-scams/.  If you have difficulty accessing the form, call our office at 800-649-2424 to report the scam over the phone.

Learn more about imposter scams on our imposter scam prevention video and resource page: ago.vermont.gov/imposter-scam


AG DONOVAN ANNOUNCES TOP 10 CONSUMER COMPLAINTS OF 2021

BURLINGTON – In recognition of National Consumer Protection Week, Attorney General T.J. Donovan announced the top 10 consumer complaints received by the Consumer Assistance Program (CAP) in 2021. CAP, a partnership between the Attorney General’s Office and the University of Vermont, offers a free mediation service for Vermont consumers, including small businesses. In 2021, CAP received 1,173 complaints and recovered more than $240,000 for Vermont consumers. Claiming the list’s top spots are complaints involving vehicles, retail, and home improvement, respectively – representing approximately 44 percent of all complaints filed.           

“I want to thank CAP for the services they provide to Vermonters. Whether they are resolving a consumer complaint, helping a Vermonter get a refund, or providing guidance to a victim of identity theft, CAP is always there to help. I encourage all Vermonters with a consumer complaint to reach out to CAP for assistance.

Attorney General T.J. Donovan

 The following are the top 10 consumer complaints received by CAP in 2021:

RankConsumer Complaint IssueNumber of Complaints
1Motorized Vehicles Common issues included defective merchandise; failure of state inspection; misrepresentation; and unsatisfactory service/repair.199    
2Retail Common issues included failure to deliver; refund policy/refund disputes; defective merchandise; and unsatisfactory service.187
3Home Improvements Common issues included unsatisfactory service/repair; criminal home improvement fraud concerns; failure to perform; improper installation; and deposit refund dispute.132  
4Health/Medical Common issues included unauthorized billing; excessive estimate/charge; and defective merchandise.83  
5Fuel Common issues included pricing complaints; refund delays; propane tank removal delays; billing disputes; contract disputes; and safety concerns.81
6Housing and Real Estate Common issues included landlord-tenant issues; security deposit disputes; and warranty of habitability disputes.77
7Banking, Credit and Finance Common issues included debt collection; credit reporting disputes; and financing/loan issues.67
8Home Furnishings Common issue included defective merchandise, often involving new appliances.59
9Athletics Common issues included refund policy disputes for seasonal passes, and failure to deliver services.30
10Delivery, Moving and Storage Common issue included delayed deliveries.29
CAP’s Top 10 Consumer Complaints of 2021

            Though not represented in the list of consumer complaints, scams continue to be of concern to Vermonters. Earlier this year, Attorney General Donovan released the top 10 scams reported to CAP. In 2021, CAP received 5,154 scam reports, up slightly from the previous year. New twists on old scams involving computer tech support and fraudulent online listings represented nearly a quarter of all reports filed by Vermonters. More information on stopping scams is available at ago.vermont.gov/cap/stopping-scams/.

            CAP offers a free mediation service to all Vermont consumers, including small businesses. If you are a consumer in need of assistance, please contact CAP by calling 1-800-649-2424 or visiting ago.vermont.gov/cap.

Home Improvement Fraud Has No Boundaries

By Cristina Leiva

A National Consumer Protection Week feature. “National Consumer Protection Week (NCPW) is a time to help people understand their consumer rights and avoid frauds and scams” (FTC). 

Fraud has no boundaries: Protect your home from home improvement fraud.
Protect Your Home from Home Improvement Fraud

Improving your home can be an overwhelming process to complete on your own. Turning to a contractor can help relieve the stress, but homeowners should be aware of the existence of home improvement fraud.

Home improvement fraud happens when a contractor promises to improve your home, but leaves the project incomplete or your home in an uninhabitable condition.

Before hiring a contractor for a home improvement project, do your research:

  1. Start by reviewing the Vermont Attorney General’s Home Improvement Fraud Registry where you’ll find the names of individuals who have been criminally convicted of committing home improvement fraud in Vermont.
  2. Review complaint history posted on websites like BBB.org.
  3. Contact the Consumer Assistance Program (CAP) and ask if any complaints have been filed against the contract you are considering.
  4. Ask your friends, neighbors, family, and co-workers about their home improvement experiences. These individuals are more than just connections; they are resources that can provide contractor references and warnings.

Tips for avoiding home improvement fraud:

  • Ask the contractor for references. Then, call the references and ask detailed questions about the work done, satisfaction, price, the time it took to complete, and how they found the contractor.
  • Find your contractor through trusted family or friends or trusted websites.
  • Pay in increments rather than a large sum/total payment upfront.
  • Once you’ve chosen who you want to hire, determine the exact timeframe and the estimated price for the job. Compare this price to makeups for similar projects (get at least three estimates).
  • Get all agreements in a written contract. Verbal statements are difficult to prove.
  • Keep your down payment to a minimum.
  • If possible, make your payment upon completion of the work; or at least make payments as the equivalent portion of the work is completed. That way, if the contractor walks off the job, you haven’t lost any money.
  • Don’t make the final payment until you are completely satisfied with the work.
  • Always request proof of insurance.

Warning signs of less than reputable contractors:

  • Door-to-door solicitations.
  • Claims that the contractor was passing by and noticed a problem with your home.
  • Discounts for finding other customers or to use your home as a demo model.
  • Offers a good price for materials left over from a previous job.
  • Only accept cash payments.
  • Uses high-pressure sales tactics and demands a decision on the spot.
  • Asks you to pay for the entire job or a substantial portion of the job up front.
  • Suggests that you borrow money from a lender the contractor knows.
  • Refuses to provide proof of insurance or legitimate contact info.

Before hiring a contractor, you should know that while Vermont law does not require home improvement contracts to be in writing, you can request a written contract outlining the terms of the agreement. If there isn’t a written contract, the contractor may disclaim liability for complications, or dispute the agreed-upon terms. When considering a contract, it’s best to read each page and verify acceptance before you sign it. Fraudulent contractors could conceal important documents underneath the agreement that could have dire consequences, including the loss of your home.  

Avoid home improvement by: Ask trusted family, friends, and neighbors for references.
Get a list of clientele recommendations from the contractor.
Research online and read reviews: 
Check online and CAP complaint history and the HIF Registry.
Contract Tips:
Get it in writing!
Pay in increments rather than full payment.
Avoid:
Door-to-door solicitors.
High-pressure sales.
Requirements to pay for the entire job or a substantial portion of the job up front. VT Consumer Assistance Program. 1-800-649-2424.
Avoid Home Improvement Fraud by the Consumer Assistance Program

If you have a problem with a home improvement project or want to research a contractor before hiring them, contact CAP for assistance by visiting ago.vermont.gov/cap or by calling 1-800-649-2424.

Free COVID-19 Test-Kit Scams

By Crystal Baldwin and Cristina Leiva

A National Consumer Protection Week feature and second in a Two-Part Series on COVID-19 Test Kits. “National Consumer Protection Week (NCPW) is a time to help people understand their consumer rights and avoid frauds and scams” (FTC). 

Earlier this week, it was announced that Americans can order more free at-home COVID-19 tests from the U.S. government at COVIDtests.gov. This second round of tests are available for free through COVIDtests.gov. There are no shipping costs, and you don’t have to give a credit card or bank account number. You only need to give a name and address. Once you place an order, you’ll get an order confirmation number. If you give your email address, you’ll also get an order confirmation email and delivery updates. Anyone who asks for more information than that is a scammer.


Don’t get scammed when doing your part to get tested!

Scammers love when things are offered for free because they can quickly create a website making the same claim, while requiring personal information and payment for additional charges like “shipping/handling” or “expediting” or “priority service”. They seize the opportunity to cash in when emotions are high—which is the case when trying to stay healthy amid a global pandemic.   

COVID-19 TEST-KIT SCAM ALERT: Unsolicited requests for your health insurance information, phony offers for FREE test kits asking for payment, Peer-to-peer sellers.
COVID-19 Test-Kit Scam Alert by CAP

COVID-19 Test Kit Scams Might Look Like:

  • Unsolicited requests for your health insurance information, such as Medicare, in exchange for free test kits.
  • Phony offers of FREE test kits with payment required, such as for shipping/handling.
  • Peer-to-peer sellers: Friends, family, neighbors and others on Facebook Marketplace and Craigslist and other listing sites.
  • Unreputable vendors in retail pop-up shops or online.
  • The sale of invalid COVID-19 test kits.
  • Unsolicited offers to obtain free test kits, such as through telemarketing, email, and other unverified channels.

Hang up on solicitations claiming to offer free test kits in exchange for your personal information, insurance, or money! If you are looking for free test kits, seek them out through valid sources outlined in the Consumer Assistance Program’s free COVID-19 test kits blog.

Look out for these red flags:

  • Requests to pay a fee for free tests.
  • Claims of expedited delivery with additional payment.
  • Receiving results after you sign up and pay, but before you’ve been tested.
  • Tests that are not FDA authorized.

If you have encountered a free COVID-19 test scam, report it to the Consumer Assistance Program (CAP) through CAP’s online scam reporting form.  

Regarding COVID-19 updates and information, the best place in Vermont to check is the Vermont Department of Health.

Resources: COVIDtests.gov, Vermont Department of Health