Dec 30, 2021 - Politics & Policy

Law protecting patients from surprise medical bills starts Jan. 1

Picture of a person holding a sign that says "Health care is a human right"
Photo: Robyn Beck/AFP via Getty Images

Patients with health insurance will no longer receive as many unexpected medical charges from emergency visits and other out-of-network health care services starting Saturday.

Driving the news: The No Surprises Act will go into effect on Jan. 1. It will require patients to pay only the in-network cost-sharing amount in those situations.

  • Patients will still be responsible for things like co-insurance payments and deductibles. But surprise out-of-network charges, which are exceptionally common, will effectively be banned.
  • The law was approved by Congress in late 2020 and gets rid of surprise medical billing, which happens when a person receives medical care by a provider outside their private insurer’s network, even if the visit takes place at an in-network facility.
  • Any outstanding charges will have to be settled between health insurers and out-of-network medical providers.
  • Ground ambulances can still bill patients separately, but the law does offer protections from surprising billing from air medical transportation.
  • The new law applies to almost all private health insurance plans provided by employers (including federal, state or local government), according to the Centers for Medicare and Medicaid Services.

By the numbers: The Kaiser Family Foundation says patients receive surprise bills in about 1 in 5 emergency room visits.

  • Additionally, between 9% and 16% of in-network hospitalizations for non-emergency care include surprise bills from out-of-network providers that the patient did not choose, like an anesthesiologist, per KFF.
  • Patients can be charged with over $1,200 for anesthesiologists' services, $2,600 for surgical assistants and $750 for childbirth-related care, CNN reports, citing a report by the Department of Health and Human Services.

What they're saying: "No patient should forgo care for fear of surprise billing," said HHS Secretary Xavier Becerra during the summer.

  • "Health insurance should offer patients peace of mind that they won't be saddled with unexpected costs ... and with this rule, Americans will get the assurance of no surprises," he added.
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