One of the provisions in the emergency COVID-19 aid package passed by Congress is designed to provide relief to everyday Americans and their employers on a scale much greater than any stimulus check ever might.
That provision bans surprise medical bills, helping protect insured patients from large medical bills when they unknowingly receive out-of-network care.
The No Surprises Act will take effect beginning in 2022.
Surprise bills can have a significant impact on the amount patients are charged for care, ranging from an increase of a few hundred dollars to other instances where patients have received surprise bills in the six figures.
Patients often cannot determine the network status of emergency room doctors or anesthesiologists. In many cases, the patient is not involved in the choice of provider at all.
Under the legislation, patients will only be required to pay in-network cost-sharing amounts for out-of-network emergency care and care provided by out-of-network providers at in-network facilities without the patient’s informed consent.
The Act applies to surprise bills from doctors, hospitals and air ambulances. It prohibits these providers from billing patients who have health coverage for unpaid balances.
It includes several changes from prior attempts to pass similar legislation.
Unlike those bills, the No Surprise Act will not establish a benchmark payment standard for insurers to pay out-of-network providers. Instead, insurers and providers will have to try to resolve payment disputes on their own. If that failed, these stakeholders could turn to arbitration.
The legislation also promises to increase transparency for all patients to better understand their cost-sharing liability ahead of time. Insurers would also have to offer price comparison information by phone, develop a web price comparison tool, and maintain up-to-date provider directories.
Ground ambulance operators will not be subject to the law. In part, that’s because many ground ambulance services are provided by local government entities.
The Mahoney Group, based in Mesa, Ariz., is one of the largest independent insurance and employee benefits brokerage in the nation. As an employee-owned organization, we’ve been protecting what’s yours since 1915. Contact us at news@mahoneygroup.com or 480-730-4920.
This article is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice.