No Surprise Billing

A series of policies were issued in the second half of 2021, designed to provide consumers (patients) with healthcare protections, starting in 2022. The No Surprises Act aimed to eliminate “surprise medical billing” for patients in employer-sponsored and individual health plans who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.

You May Be Wondering, “What Is Surprise Billing?”

When patients receive care from an out-of-network provider, they can often be billed for the difference between the charges the provider bills and the amount paid by their health plan. This is known as “balance billing,” and an unexpected balance bill is a surprise bill. Before these new regulations, health plans typically did not cover the entire out-of-network costs, leaving patients with potentially excessive, unaffordable medical bills.

What Exactly Does the No Surprise Act Outline?

If you have health insurance – whether it’s through your employer, a marketplace plan, or an individual plan – these are the new protections you have:

• There are no surprise bills for emergency services, even if they are out-of-network and have no prior authorization approvals.
• There are no out-of-network charges and balance bills for extra care, such as radiology or anesthesiology, by out-of-network providers who work at an in-network facility.
• No out-of-network cost-sharing for all emergency and non-emergency services. This refers to things like out-of-network coinsurance or copayments. You cannot be charged more than in-network costs for these services.

This legislation also looks out for those without health insurance coverage. Patients who don’t have insurance or choose to self-pay must now receive a “good faith estimate” of all costs associated with care before getting the care. This will help you understand your expected costs and compare them against future bills.

And although you may not be aware, patients covered under the following plans are already protected against surprise medical billing: Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE.

There’s much information to process, but it is essential that you know your rights regarding healthcare coverage. These new regulations help ensure you get the healthcare you need, with some clarity around how much it will cost.

There is an abundance of additional information that can be located on the Centers for Medicare & Medicaid Services website.