New Law to Ban Many Surprise Medical Bills

Patients fed up with receiving surprise medical bills might get some relief beginning in 2022.

The pandemic stimulus and federal funding package that President Donald J. Trump signed into law this week contains a law — the No Surprises Act — that generally bans the practice of balance billing without a patient’s advance consent.

This costly maneuver occurs when an out-of-network medical provider treats you without you realizing that the provider is not in your insurance company’s network.

For example, an out-of-network doctor may treat you in an emergency situation. It’s even possible that an out-of-network physician or laboratory would provide care for you at an in-network hospital.

Currently, insurance companies can bill patients for the difference between the provider’s charge and the amount allowed by the patient’s insurer.

For example, such a balance-billing process might be used if the provider’s charge is $100, but your insurance company’s allowed amount is just $70. In that case, you would owe the $30 necessary to pay the difference between the two amounts.

However, this practice effectively will become illegal on Jan. 1, 2022. Specifically, out-of-network providers generally will not be able to balance-bill you unless they notify you that they are out of network and give you an estimate of charges 72 hours before treating you, and you consent to receiving that out-of-network care.

The new law does not cover all medical services. NPR reports that the bill does not extend to ground ambulance services, for example.

However, Zack Cooper, an associate professor of public health and economics at Yale University who studies health care pricing, still praised the new law. He tells NPR:

“No law is perfect. But it fundamentally protects patients from being balance-billed. That’s a remarkable achievement.”

The new law offers other protections. Consumer Reports says it guarantees that all emergency room medical care will be billed to consumers at the “in-network” rate. That is true even if the hospital or individual health care provider is not in the patient’s insurance network.

The law also mandates that insurers and health care providers work together to determine payment amounts. In the past, patients often have had to negotiate payment of surprise medical bills on their own.

Consumer Reports notes that the new law applies to most types of health insurance, including those offered through the Affordable Care Act marketplace. However, the law does not apply to short-term health insurance plans that typically cover people for six months or less.

For more ways to contain your medical costs, check out “5 Ways Anyone Can Save on Out-of-Pocket Health Care Costs.”