No Surprises Act Protects Patients From Unexpected Medical Bills
Patients now have protection against unexpected—and often extraordinarily high—medical bills. On January 1, 2022, the Biden-Harris administration’s bipartisan No Surprises Act went into effect to ban surprise billing (https://www.hhs.gov/about/news/2022/01/03/hhs-kicks-off-new-year-with-new-protections-from-surprise-medical-bills.html) in private insurance for most emergency care and many instances of nonemergency care, according to the U.S. Department of Health and Human Services (HHS).
Surprise medical bills are unexpected bills from an out-of-network provider, facility, or air ambulance provider. According to a report (https://aspe.hhs.gov/sites/default/files/documents/acfa063998d25b3b4eb82ae159163575/no-surprises-act-brief.pdf) from the HHS Office of the Assistant Secretary of Planning and Evaluation, “18% of emergency room visits by people with large employer coverage result in one or more out-of-network bills and nearly 20% of patients undergoing in-network elective surgeries or giving birth in a hospital received surprise bills.” The agency found that costs ranged from $750–$2,600 (https://aspe.hhs.gov/sites/default/files/documents/acfa063998d25b3b4eb82ae159163575/no-surprises-act-brief.pdf) per episode and more than half of U.S. consumers reported receiving an unexpectedly large medical bill.
For insured individuals, HHS said (https://www.hhs.gov/about/news/2022/01/03/hhs-kicks-off-new-year-with-new-protections-from-surprise-medical-bills.html) the No Surprises Act will:
- Ban surprise bills for emergency care and require that cost sharing for services, like copays, be based on in-network rates, even when care is received without prior authorization.
- Ban surprise bills from certain out-of-network providers at in-network hospital for a procedure.
- Require providers and facilities to provide easy-to-understand notices that explain the applicable billing protections and who to contact if patients have concerns.
For uninsured individuals, HHS said the act requires providers to give a good-faith estimate (https://www.hhs.gov/about/news/2022/01/03/hhs-kicks-off-new-year-with-new-protections-from-surprise-medical-bills.html) of costs before providing nonemergency care that might include expected charges for a primary item or service as well as costs for any other items or services that are reasonably expected. If the final bill exceeds the good-faith estimate by $400 or more, uninsured or self-pay customers can dispute the final charges.
“The No Surprises Act offers significant relief to people across the country and reinforces our fundamental belief that no one should go bankrupt when seeking necessary care,” Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure said (https://www.hhs.gov/about/news/2022/01/03/hhs-kicks-off-new-year-with-new-protections-from-surprise-medical-bills.html). “We are making it easy for consumers to know and understand the rights under the law, including what they can do if they receive a surprise medical bill. Consumers will not only benefit from these rights but also will be empowered with the knowledge to address potential violations.”