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New COVID-19 Law Protects Patients From Receiving Surprise Medical Bills

The Consolidated Appropriations Act, 2021 intends to protect patients from surprise bills, limiting patient responsibility to what they would otherwise be responsible for if they had received care from an in-network provider.

Buried in the Consolidated Appropriations Act, 2021, is something called the No Surprises Act, which amends the Public Health Services Act and will take effect on January 1, 2022.

In a video interview, Jae Oh, author of Maximize Your Medicare, said the new law protects patients from receiving surprise medical  bills.

Beginning Jan. 1, 2022, patients will be  protected from surprise medical bills that could arise from out-of-network emergency care, certain ancillary services provided by out-of-network providers at in-network facilities, and for out-of-network care provided at in-network facilities without the patient’s informed consent, according to the American Hospital Association. Read Detailed Summary of Health Provisions in  Consolidated Appropriations Act, 2021.

According to the AHA, "patients will be required to pay only the in-network cost-sharing amount, which will be determined through a formula established by the HHS Secretary and will count toward the patient’s health plan deductible and out-of-pocket cost-sharing limits. Providers will not be permitted to balance bill patients beyond this cost-sharing amount. Both providers and health plans will be required to inform patients about these protections. Violations could result in state enforcement action or federal civil monetary penalties of up to $10,000. In certain instances, an out-of-network provider still may be permitted to bill a patient more than the in-network cost-sharing amount for care. However, the provider would need to give the patient notice of their network status and an estimate of charges, as well as obtain the patient’s written consent, prior to the delivery of care."

The law does not extend to ground ambulances, according to Oh.

So what recourse do patients have who receive a surprise medical bill?

First, Oh recommends, contacting your health insurance provider. 

"The insurance company should be able to provide you with answers in terms of what was intended to be charged to you," said Oh. 

And second, contact your state's insurance department.

Additional resources

Congress Passes Surprise Medical Bill Legislation

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