Due to the added burden of out-of-network healthcare costs, the stress of undergoing a stint in the emergency room or hospital often continues well after a patient is discharged. However, beginning Jan. 1, 2022, healthcare providers will no longer be legally authorized to bill their patients more than the in-network price of the medical services that they receive, even if the patient is being treated by an out-of-network provider.
This so-called surprise billing typically arises after a medical emergency (when a patient visits an out-of-network facility or is treated by an out-of-network physician) or an elective care procedure. In the case of the latter, patients may choose an in-network facility and physician, but their health insurers can opt to separately contract with ancillary providers that are outside of the patient’s network.
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To counteract this growing burden of excessive healthcare charges, the No Surprises Act requires that health insurance plans treat the cost of any out-of-network services as though they were in-network. The act also grants out-of-network providers the opportunity to protest the payments they receive from insurers.
Notable Perks of the No Surprises Act:
- All commercially-insured enrollees will be protected (excluding public insurance programs that are already safeguarded from surprise bills such as Medicaid and Medicare)
- If there is a gap in a patient’s health insurance coverage for care provided by out-of-network clinicians at in-network facilities or emergency services (including air ambulances), patients will be protected from receiving surprise medical bills. Despite costing patients an average of $450 (after insurance is applied), ground ambulance transport is exempt from the No Surprises Act.
- Healthcare providers and insurers will be able to independently resolve any disputes that may arise around reimbursement.
- Patients will only be held accountable for paying their in-network cost-sharing amount.
To learn more about the No Surprises Act, check out the American Journal of Managed Care’s website.
Jeanette Pavini is an Emmy Award winning journalist specializing in consumer news and protection. She is the author of “The Joy of $aving: Money Lessons I Learned From My Italian-American Father & 20 Years as a Consumer Reporter.” Jeanette is a regular contributor to TheStreet. Her work includes reporting for CBS, MarketWatch, WSJ Sunday, and USA Today. Jeanette has contributed to “The Today Show” and a variety of other media outlets. You can follow her money saving tips and ways to give back on Facebook: Jeanette Pavini: The Joy of $aving Community. Find links to her social media and her book at JeanettePavini.com.