The No Surprises Act aims to eliminate unexpected medical bills.
If you're like most Americans, the phrase "invoice" is probably the last thing on your mind. "Surprise invoice," on the other hand, is a whole new level of terror.
If you haven't had it happen to you, chances are you've heard of it happening to someone you know: receiving an unexpected medical bill in the mail for thousands of dollars after a recent ER visit.
This is a common occurrence. In fact, according to a 2020 Kaiser Family Foundation poll, 18 percent of emergency hospital visits result in at least one surprise charge.
Congress passed a bill on Jan. 1, 2022, that specifically prohibits these kinds of surprises.
The No Surprises Act protects people from unexpected medical expenditures by adding a layer of safety. While it won't eliminate all billing surprises, it should help alleviate concerns, particularly in emergency situations where consumers don't have time to hunt for an in-network doctor.
The law's protection for insured patients
You don't have time to check up on whether facilities accept your insurance when you need help right away. The term "emergency" refers to a situation that requires immediate attention.
As a result, if you visit an out-of-network provider, you may be surprised by a medical cost in the tens of thousands of dollars. The majority of Americans, according to national polls, are afraid about not being able to afford a surprise medical cost.
This behavior is particularly addressed by the new law, which took effect on January 1.
The new restrictions apply to people who have health insurance:
When you obtain emergency care (such as an ER visit or an air ambulance), or when you receive non-emergency care at an in-network institution but are unwittingly treated by an out-of-network physician, you should avoid receiving surprise expenses. Yes, this is possible). In-network pricing must also be used to compute co-pays and other cost-sharing for services.
If you go to an in-network hospital for care, you won't get any surprise fees from out-of-network physicians. As a result, while you're there, cost-sharing for new services will be based on in-network rates.
Providers and facilities must give patients clear notices outlining applicable billing safeguards as well as a phone number to call if they have any questions.
The law's protection for uninsured patients
You are deemed "self-paying" if you are not covered by an employer or have an individual health care insurance plan. You must fund all bills out of pocket.
Before providing you with non-emergency care, the No Surprises Act safeguards you by requiring providers to provide you with a "good faith estimate" of total expenses.
The estimate must include projected costs for both the primary service you're receiving and any reasonably anticipated supplementary services. If you are self-paying and need surgery, for example, the estimate must cover the cost of surgery, diagnostic testing, anesthesia, and so on.
You have the right to challenge final charges if they are more than $400 more than the good faith estimate.
Other safeguards may be available in your state.
Many states (more than 30), according to the Commonwealth Fund, have implemented surprise medical billing measures, although just 17 are deemed comprehensive.
Non-emergency scenarios at in-network hospitals are covered by the states that are considered comprehensive. They do, however, apply to specific types of insurance and scenarios.
While most insurance plans are covered by federal law, there are still some aspects in state law that differ from federal law. In these circumstances, federal law will give way to state law.
If you have any questions about your medical costs, contact your lawyer.
Receiving a large bill in the mail isn't fun, especially when it's unexpected. Laws governing unexpected medical costs can be perplexing, especially when they change. Consult an attorney to learn about your rights and what to do if you receive an unexpected medical bill.