An unexpected medical bill is one surprise no one ever wants to receive. As of January 1, 2022, the No Surprises Act protects patients from surprise bills for most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. With this new protection to prevent surprise medical bills, those with private health insurance should know about their rights.
WHAT ARE SURPRISE MEDICAL BILLS?
A surprise medical bill, also called “balance billing” or “out-of-network billing,” occurs when a patient receives care from an out-of-network provider or an out-of-network facility and is billed for the difference between the billed charge and the amount paid by the patient’s health plan. This bill could be for services such as anesthesiology or laboratory tests or when you can’t control who is involved in your care – like in an emergency. And because health insurance may not cover the entire out-of-network costs, the patient could be left with higher costs than if care had been provided by an in-network provider or at an in-network facility.
HOW DOES THE NO SURPRISES ACT PROTECT ME?
With nearly 50% of insured Americans receiving medical coverage from their employer, this new protection is making a difference in employees’ lives. When health coverage is provided through the employer, these new rules will apply:
Ban surprise bills for most emergency services, even if they are from an out-of-network provider or without approval beforehand (prior authorization).
Ban out-of-network cost sharing, like out-of-network coinsurance or copayment, for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
Ban out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers that work as part of a patient’s in-network facility.
Require that health care providers and facilities give you an easy-to-understand notice explaining that getting care out-of-network could be more expensive and options to avoid balance bills.
STILL HAVE QUESTIONS?
If you have more questions reach out to ANCO Insurance at 1-800-749-1733 to begin a conversation on navigating employee benefits, including group health insurance.