In January 2022, a new law goes into effect limiting “surprise” medical bills, or bills insured patients receive for out-of-network care, either in emergency settings, or from out-of-network providers at in-network facilities. Congress passed the No Surprises Act as part of the 2020 year-end omnibus spending bill and, while many details of the No Surprises Act are still forthcoming as federal agencies engage in the necessary rulemaking (which may not be complete by the Act’s effective date), health care providers, facilities, insurers, and health plans should act now to ensure they are ready to comply with the Act’s requirements.
What is surprise billing?
In the context of the No Surprises Act, a “surprise bill” occurs when a health care provider or facility balance bills a patient the difference between the facility or provider’s billed charges, and a health plan’s out-of-network benefit. These bills are often a surprise because the patient either was not able to choose whether to use an in-network or out-of-network facility or provider, or was not aware that the provider was out-of-network until after the services were rendered.
For example, if a patient is injured in an accident and is unconscious, the patient may be taken to an out-of-network emergency room. Another example is when a patient chooses an in-network facility and an in-network primary provider, but is unaware that other providers, such as anesthesiologists, or specialists brought in to address complications, are not in-network. In both scenarios, patients can end up with large, out-of-network bills through no fault of their own.Read More