Billing / No Surprises Act · 17 Feb 2022

No Surprises Act

On January 1st, 2022, the No Surprises Act went into effect and it provides federal protections for patients from surprise medical bills!  

For those that don’t remember, surprise medical bills can happen when someone receives a bill for care they thought should be covered by their insurance.

Very frequently this happens when patients seek emergency care for things like a heart attack or stroke, only to find out later that the emergency care provided was out-out-of-network. You have no way to know this ahead of time and the last thing you should be worried about in an emergency situation is the cost of your care.

In non-emergency situations you may have done your due diligence and sought care at an in-network hospital, only to receive a surprise bill months (can be more than a year) later because the doctor or other providers associated with your care may not work for the hospital and do not take your insurance.

Beginning this month, consumers with group or individual health plans are protected from receiving surprise medical bills for most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance providers.

Specifically, this law will:

  • Ban surprise bills for most emergency services even if you get them out-of-network and without prior authorization.
  • Ban out-of-network cost-sharing for most emergency and some non-emergency services.
  • Ban out-of-network charges for certain services like anesthesiology or radiology furnished by out-of-network providers as part of a patients’ visit to an in-network facility.
  • Require that health care providers and facilities give you an easy-to-understand notice explaining your new protections and who to contact if you have concerns.
  • Require health care providers to seek patient consent to waive surprise medical billing protections.

For a more detailed information about the new law, we encourage you to refer to CMS resources about the No Surprises Act.