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The "No Surprises Act" Bans 'Surprise Billing' After Medical Care

Posted by Angela Spigarelli | Jan 07, 2022 | 0 Comments

Finally.  A Bipartisan Law We Can All Support.

At a time when our nation seems more divided than ever, lawmakers from both sides came together to pass new legislation aimed at protecting Americans from financial hardship after receiving medical care.  Starting January 1, 2022, the “No Surprises Act” goes into effect.  This new consumer protection law will ban surprise billing, or “balance billing” for 1) patients in emergency situations and 2) patients who scheduled a medical procedure at an in-network facility, but unknowingly received care from a provider outside of their health insurance plan's network.   

Most of us are careful in selecting an in-network hospital or provider prior to scheduling a planned medical procedure, such as a colonoscopy or knee surgery.  Choosing a provider that is within your plan's network ensures that the service is covered at the contracted rate and the patient can't be billed for the remainder or “balance” of the bill.  However, prior to the “No Surprises Act”, it was still possible for the patient to receive a bill for out of network charges from a provider in the chain of care that they did not choose.  In emergency situations, the patient has no choice who is providing their care or what facility they will be taken to following an accident or medical emergency.  Sometimes the patient is not even conscious at the time care decisions are made, yet they are stuck with the resulting astronomical medical bills.    

Here are two common examples of what the “No Surprises Act” was designed to fix:

Scenario One:   John is in an automobile accident and suffers catastrophic injuries. A decision is made by emergency responders that John requires transport by air ambulance to a specialized care hospital.  The average air ambulance transport cost is around $80,000.   Since the air ambulance company is out of network for John's plan, his health insurance pays what they consider reasonable and necessary, usually ranging anywhere from approximately $6,000 for Medicare and up to around $12,000 for private health insurance.  The air ambulance company then bills John for the remainder or “balance” of the bill.  Surprise!  John owes $60,000 out of his pocket for emergency medical care.

Scenario Two:  Jane schedules a routine colonoscopy which is covered by her health insurance plan.  Jane's doctor and the hospital where the colonoscopy is performed are both in-network for her plan.  However, following the surgery, Jane gets a bill from the anesthesiologist who was present during the colonoscopy but is out of network for Jane's plan.  Surprise!  Jane owes $5,000 out of her pocket for a covered medical procedure at an in-network hospital.   

The “No Surprises Act” eliminates this type of surprise balance billing and helps minimize financial hardship to patients and their families after receiving medical care.  Health insurance plans and the providers will now have to settle outstanding bills without involving the patient.

For more information about the “No Surprises Act”, please visit the U.S. Department of Health and Services link below:

HHS Announces Rule to Protect Consumers from Surprise Medical Bills | HHS.gov

About the Author

Angela Spigarelli

Areas of Practice Auto Accidents Premises Liability Insurance Claims Bar Admissions: Kansas, 1998 Missouri, 1999 U.S. District Court District of Kansas, 1998 Education: Washburn University School of Law, Topeka, Kansas J.D. – 1998 The University of Kansas, Lawrence, Kan...


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