Just before the close of 2020, Congress passed a new bill to add protections for healthcare consumers. The bill, named The No Surprises Act, will go into effect in 2022 and was designed to help protect patients from surprise medical bills.

The Problem

When a patient experiences a medical emergency, it can result in hefty medical bills. Even people with health insurance may wind up receiving out-of-network care if they are taken to an emergency room or put in a situation where they have little choice about the type of care they receive.

These bills cause healthcare affordability issues for many people. In fact, a recent KFF poll found that 2 out of 3 people worry about unexpected medical bills.

The No Surprises Act

Starting on the first day of January 2022, health plans will be required to cover out-of-network costs for surprise emergency services. While the bill does include emergency services like air lifts, it does not extend to ground ambulances. The bill also bars out-of-network providers from charging patients more than their in-network provider would charge.

In certain situations, the No Surprises Act can also apply to nonemergency services. These surprise bills usually come up when an out-of-network expert—like an anesthesiologist—is called in to provide ancillary services. In this case, the patient may not know that the doctor is out-of-network, so the No Surprises Act will require healthcare providers to charge this as an in-network expense.

What is going to change?

The bill covers almost all employee health plans, as well as non-group health insurance plans. For employers, the new law means that they must adopt the new provisions or face federal fines. Penalties for violating the law can reach up to $10,000 per violation.

In addition to covering out-of-network emergency expenses, healthcare providers are also going to be required to provide patients with information about their care in advance. For pre-scheduled appointments, patients will be able to request information about how their care will be provided, as well as an approximate cost estimate. Health plans also must give patients transitional coverage for ongoing care at a provider that has been moved out-of-network.

Implementation Issues

Even as the 2022 deadline approaches, there have been questions about how the new law will be enforced. Although the law does call for stiff penalties and a consumer complaint process, it’s unclear if this will be enough to enforce the law. Consumers are often unaware of the complaint processes open to them.

Got questions about employee benefits and how this new bill might affect you, LBMC Employment Partners is here to help. Contact us today!