No Surprises Act

New Protections from Surprise Medical Bills

You may have heard stories from friends or news about balance bills or surprise bills from health care providers. Starting in 2022, a new law went into effect – the federal No Surprises Act – that protects you from many types of surprise bills. Here are the basics about the new protections and some examples of how they can protect consumers:

What is balance billing?

Balance billing happens when a health care provider (a doctor, for example) bills a patient after the patient’s health insurance company has paid its share of the bill. The balance bill is for the difference between the provider’s charge and the insurance company’s price after the patient has paid any copays, coinsurance, or deductibles.

Balance billing can happen when a patient receives covered health care services from an out-of-network provider or an out-of-network facility (a hospital, for example).

In-network providers agree with an insurance company to accept the insurance payment in full and don’t balance the bill. Out-of-network providers don’t have this same agreement with insurers.

Some health plans, such as Preferred Provider Organization (PPO) or Point of Service (POS), include coverage for out-of-network care. However, the provider may still balance the bill for the patient if state or federal protections don’t apply. Other plans don’t include coverage for out-of-network services, and the patient is responsible for all out-of-network care costs.

Medicare and Medicaid have their own protections against balance billing.

 
 

Download the Consolidated Appropriations Act FAQ PDF for more info.

 

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