For many years, a nagging fear tugged at many patients receiving emergency medical services: “What if a doctor outside my health insurance network treats me, and I’m stuck with the bill?”
Such concerns were reasonable. Each year, consumers receive billions of dollars worth of such medical bills, according to The New York Times.
However, with the turn of the calendar to 2022, these worries faded into history. Thanks to that increasingly rare occurrence — bipartisan congressional legislation — many surprise medical bills like these now are illegal.
The No Surprises Act of 2020 largely prohibits the practice of balance billing without a patient’s advance consent. This type of billing usually applies when a medical provider treats you and — unbeknownst to you — is not in your insurance company’s network.
As we reported shortly after the legislation was signed into law in December 2020:
“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.”
The No Surprises Act changed that. It applies to nearly all emergency services. So, if you go to the emergency room or an urgent care center, you cannot be charged for a higher amount than the cost-sharing total you would be expected to pay for in-network services.
Despite the legislation’s protections, one key type of emergency health care service does not fall within its rules. As we reported in 2020, the No Surprises Act does not cover ground ambulance services. On the other hand, it does cover air ambulances.
According to the NYT, legislators determined that ground ambulances “would need a different regulatory approach.” Congress established a commission to study the issue, but no decisions have been made to date.
In addition, for scheduled hospital services — such as a colonoscopy — you must receive your care in a facility and from a main doctor both of which are in your health insurance plan network.
If you fail to do this, you will not enjoy the protection of the No Surprises Act. This is because the law only prohibits balance billing by a provider that a patient did not choose — a situation that generally is limited to urgent care.
For that reason, among others, it is still important to exercise care when choosing any health care provider. So, rather than simply assuming the No Surprises Act will cover you, make sure you talk to your health insurance company prior to receiving services to make sure your plan will cover the bill to the degree that you expect.
Finally, it is important to note that the law does not protect you from having to pay a deductible or a copayment, even in emergency care situations.
The No Surprises Act was passed during President Donald Trump’s administration, and President Joe Biden’s administration since has fine-tuned the rules, according to the NYT. But the law did not take effect until Jan. 1, 2022.
In an interview with the NYT, Sen. Bill Cassidy (R-La.), who helped write the bill, said:
“I think this is so pro-consumer, it’s so pro-patient — and its effect will eventually be felt by literally everybody who interacts with a health care system.”
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