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A federal law going into effect on Jan. 1 is meant to cut down on surprise medical expenses and safeguard millions from unexpected medical bills.
The No Surprises Act is part of legislation meant to protect patients who unknowingly receive care that is not covered by their insurance.
In many cases, an out-of-network provider can charge patients for the difference between what the provider is billing and the amount the patient’s insurance company will pay. This is called balance billing and an unexpected balance bill is called a surprise bill.
“The biggest changes are emergency department visits actually,” said founder and CEO of a Better Way Advocacy Chris Van Haren. “It requires that whether you visit an emergency department that’s in-network or out of network, that you only be charged the amount that you would expect to pay from an in-network emergency department. That includes the actual facility, and any doctors, any lab work, any diagnostic imaging you have.”
As part of the legislation, new rules mean excessive out-of-pocket costs will be restricted and emergency services must continue to be covered without prior authorization regardless of whether or not a provider or facility is in-network.
“Right now patients are held responsible for the care not covered by their insurance, throwing millions of Americans into financial crisis when they receive these bills that are sometimes hundreds, thousands or even tens of thousands of dollars of unexpected medical cost,” said Nancy Brown, CEO of the American Heart Association.
“Patients may receive a surprise medical bill when they unknowingly receive care from a doctor or another healthcare provider who is outside their insurance company’s network. Sometimes, these surprise bills come in emergency situations when the patient is unable to choose their medical transport company, their hospital or their doctor,” said Brown.
After many lengthy delays, Congress approved the No Surprises Act with bipartisan support in December of 2020.
