There’s one less thing privately insured Americans need to worry about if they experience a medical emergency: getting an unexpected bill from a health care provider who was involved in their treatment but was out of their insurance plan’s network — a practice that used to happen in about 1 in 5 emergency room visits, according to the Kaiser Family Foundation (KFF).
These so-called surprise medical bills — which often arose when patients had little or no say in where they received care or who gave it — became illegal starting Jan. 1, 2022, under a law called the No Surprises Act. The law is expected to save millions of Americans with individual or employer-sponsored health plans hundreds, if not thousands, of dollars in unforeseen medical expenses in certain situations, while helping to drive down insurance premiums overall.
Emergency services, even if they’re provided out of network, now must be covered at a patient’s in-network rate. And people who receive routine care at in-network facilities no longer have to fear extra bills from out-of-network providers who were involved in their care without their knowledge. For example, an out-of-network surgical assistant who helped your in-network surgeon cannot bill you more for services — the same goes for the anesthesiologist who put you to sleep and the radiologist who read your X-rays. Patients are liable only for their expected in-network cost sharing amount in these situations; insurers and providers are left to settle the rest.
What are the new protections against surprise billing?
The No Surprises Act:
- Bans surprise billing for emergency services, including air ambulance services.
- Bans out-of-network cost sharing for all emergency and some non-emergency services.
- Forbids out-of-network providers to bill patients for ancillary care (like an anesthesiologist or assistant surgeon) at in-network facilities.
Source: Centers for Medicare & Medicaid Services
“This new law will make sure that you won't get a bill that looks any different than the one you would have gotten if you were using an in-network provider,” says Jack Hoadley, research professor emeritus at Georgetown University’s McCourt School of Public Policy. (Surprise billing was already prohibited under Medicare and Medicaid.)
Air ambulances, which can cost tens of thousands of dollars, are also forbidden from charging privately insured people out-of-network fees under the new law. “If you're in the unfortunate situation where you have to take a helicopter or plane for medical reasons, even if that's an out-of-network provider, you shouldn't get a bill,” says Erin Duffy, a research scientist at the Schaefer Center for Health Policy and Economics at the University of Southern California. Ground ambulances, however, are exempt from the rule.