Key Points:
Law takes effect January 1, 2022
Protects consumers from “surprise” medical bills
In December 2020, the No Surprises Act, was signed into law. This new law is designed to protect consumers from surprise medical bills related to “surprise” and “balance” billing and becomes effective on January 1, 2022.
Who is Included?
The new billing restrictions apply to all patients covered under commercially insured policies – such as Federal Employees Health Benefits Program (FEHBP). The new rules don’t apply to people covered by public insurance programs such as Medicare, Medicaid, and TRICARE because these programs already provide protection against surprise bills.
Yes, some states already have laws that regulate surprise OON billing; however, this new federal law will supersede state laws and offer more consumer protection.
What protections are included in the new law?
No Surprises Act provides protection against “surprise billing” and “balance billing” under certain circumstances. Please note that ground ambulance transport is excluded from the new law.
“Surprise billing” occurs when you receive an unexpected bill from a non-participating healthcare provider, facility, or air ambulance service for healthcare. Surprise billing can occur when you seek emergency care and have little or no say in the facility or provider who serves you. It can also happen when you receive non-emergency/elective services at participating (in-network) facilities, but you receive some care from non-participating (out-of-network) providers. For example, you may select the facility and physician, but not the anesthesiologist or the assistant surgeon.
“Balance billing” refers to receiving a bill from a non-participating provider, facility, or air ambulance provider for the difference between the non-participating provider’s charge and the amount payable by your health plan.
Under the new law, it is illegal for providers to bill patients for more than the participating (in-network) cost-share due under the patient’s insurance in almost all cases where non-participating (out-of-network) bills occur. Health plans must treat these out-of-network services as though they were in-network at a participating provider to calculate patient costs.
There are exceptions to this balance billing prohibition, for example, when a patient is adequately notified and consents to receiving care from an out-of-network provider at an in-network facility. In this scenario, the additional cost isn’t considered a surprise.
For information about additional consumer protections included in the No Surprises Act, visit the Centers for Medicare & Medicaid Services here.
Publish Date: November 2, 2021 © Tangerine, Inc. All rights reserved. The information contained herein constitutes general information and is not directed to, designed for, or individually tailored to, any particular individual or circumstance. This article is not intended to be a client-specific analysis or recommendation. Do not use this article as the sole basis for any financial decisions. Consider all relevant information. Information should not be considered as tax or legal advice. You should consult with your tax advisor and/or attorney regarding your individual circumstances.