The No Surprises Act was passed to protect patients from surprise medical bills, which can be a huge financial burden.
The law was signed into effect on January 1, 2022.
This new law ensures that patients will not receive unexpected medical bills for emergency services or treatments that are covered by their insurance.
The No Surprises Act applies to emergency services, out-of-network care, and air ambulance services.
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What is the No Surprises Act?
The No Surprises Act is a federal law that protects consumers from surprise medical bills. It was signed into law on December 27, 2020, as part of the Consolidated Appropriations Act, 2021 (CAA).
The law aims to prevent surprise billing when patients receive emergency care or non-emergency care from out-of-network providers at in-network facilities. This can happen when patients don't know the provider or facility is out-of-network until they receive the bill.
Here are some key protections under the No Surprises Act:
- Surprise bills for most emergency services are prohibited, even if you get them out-of-network and/or without approval beforehand.
- Out-of-network cost-sharing for most emergency and some non-emergency services is prohibited.
- Out-of-network charges and balance bills for supplemental care by out-of-network providers who work at an in-network facility is prohibited.
- Health care providers and facilities must give you an easy-to-understand notice explaining that getting care out-of-network could be more expensive and they must give you options to avoid balance bills.
- Other protections in the new law require health plans to keep their provider directories updated.
- You are not required to use your insurance if the service you need isn’t covered, or it’s less expensive if you pay out of pocket.
- When you aren’t using insurance, in most non-emergency cases, providers and facilities must give you a good faith estimate when you schedule care at least 3 business days in advance, or if you ask for one.
When Was the No Surprises Act Passed?
The No Surprises Act was passed on December 27, 2020, as part of the Consolidated Appropriations Act of 2021.
This law aimed to protect patients from surprise medical bills, which can occur when patients receive unexpected charges for out-of-network care.
The No Surprises Act went into effect on January 1, 2022, giving patients and healthcare providers time to adjust to the new rules.
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Background
The No Surprises Act was signed into law on December 27, 2020, as part of the Consolidated Appropriations Act of 2021. This legislation aims to address surprise medical billing at the federal level.
Most sections of the No Surprises Act went into effect on January 1, 2022, for all hospitals, health systems, and health plans. This date marked the start of a new era in protecting patients from surprise medical bills.
The Departments of Health and Human Services, Treasury, and Labor will issue regulations and guidance to implement the numerous provisions of the No Surprises Act. This will help ensure a smooth transition for patients and healthcare providers alike.
The No Surprises Act prohibits balance billing for emergency services and in instances where healthcare services are received from an out-of-network provider at an in-network facility for federally regulated health insurance products.
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No Surprises Act
The No Surprises Act was signed into law on December 27, 2020, as part of the Consolidated Appropriations Act, 2021.
Most provisions of the No Surprises Act went into effect on January 1, 2022, protecting consumers from surprise medical bills for emergency services, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
The law prohibits balance billing for emergency services and in instances where healthcare services are received from an out-of-network provider at an in-network facility. Patient cost-sharing is limited to the in-network amount.
Here are some key protections under the No Surprises Act:
- Surprise bills are not allowed for covered emergency out-of-network services, including air ambulance services.
- Surprise bills are not allowed for covered non-emergency services performed by an out-of-network provider at an in-network facility.
- You cannot be asked to waive your protections and agree to pay more for out-of-network care at an in-network facility.
If you get health coverage through your employer or have an individual or family health plan, these protections apply:
- Surprise bills for most emergency services are prohibited, even if you get them out-of-network and/or without approval beforehand.
- Out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services is prohibited.
- Out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers who work at an in-network facility is prohibited.
You have the right to receive a good faith estimate of your potential bill for medical services when scheduled at least three days in advance.
Frequently Asked Questions
Has the No Surprises Act been successful?
The No Surprises Act has been successful in protecting patients from over 10 million surprise medical bills. This milestone highlights the law's effectiveness in reducing unexpected medical expenses.
Sources
- https://insurance.utah.gov/consumers/health-insurance/no-surprises-act/
- https://www.hopkinsmedicine.org/patient-care/patients-visitors/billing-insurance/no-surprises-act
- https://www.health.state.mn.us/facilities/insurance/managedcare/faq/nosurprisesact.html
- https://calhospital.org/no-surprises-act/
- https://www.sheppardhealthlaw.com/2021/11/articles/healthcare-information/relief-from-surprise-bills-congress-passes-no-surprises-act/
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