Say goodbye to surprise medical bills
January brought good news for Americans who are covered by private health insurance. Thanks to a new federal law, patients are less likely to receive surprise medical bills. Experts are calling the No Surprises Act the most significant federal healthcare law since the Affordable Care Act.
A surprise medical bill arrives after an emergency visit, hospital stay, or outpatient visit, sometimes weeks or months after. It is a balance bill. The hospital or healthcare provider bills the patient for the portion of the medical bill not covered by insurance.
A 2019 survey by the American Cancer Society Cancer Action Network found that nearly one-quarter of cancer patients have had a surprise medical bill. Of these, 62 percent were over $500, with 21 percent being over $3,000. One in five emergency room visits leads to a surprise bill.
Surprise bills often come from out-of-network (OON) providers. The provider could be a doctor, lab, ambulance company, or other medical service outside the insurance plan’s network. In many cases, patients do not even know they used an OON provider until the bill arrives.
The No Surprises Act passed in late 2020 as part of a large-scale pandemic relief bill. The final details were hammered out in 2021 before taking effect on January 1, 2022.
The bill passed with support from both Democrats and Republicans. Despite interest from both sides, the bill still required compromise. A stand-alone bill introduced in 2019 stalled due to lack of agreement on the types of services to be included and how costs formerly billed to patients would be covered.
In recent years, many states have passed laws attempting to limit surprise medical bills. These laws varied tremendously, were harder to understand, and did not offer the same level of protection as the new law.
What this means for you
If you have private health insurance, the No Surprises Act protects you from most unexpected medical bills. According to University of Pennsylvania Leonard Davis Institute Fellow Benjamin Chartock, who studies healthcare management and economics, the benefits are clear: “For patients who end up with a surprise bill — a bill for the out-of-network care they thought would be in network — the No Surprises Act is a welcome development in that patients will no longer have a second emergency, the first emergency being the medical care they needed and the second emergency being the surprise out-of-network bill.”
Chartock likens surprise billing to an orchestra concert. You pay for your ticket, attend the concert, then weeks later get a bill from the oboe player. A surprise medical bill is for just one small but sometimes pricey part of a medical service.
This law brings some relief to people with breast cancer who have often faced surprise medical bills. A 2017 study found that 21 percent of women with employer insurance who had mastectomies at in-network hospitals later got a surprise bill from an OON provider – most often for lab services.
People with cancer sometimes experience financial hardship due to illness. Money worries can keep people from seeking care when needed. The new law may change that. Insured people can go to the emergency room without fear of unexpected bills.
The new law also offers uninsured Americans added protection. Healthcare providers now must give a good faith estimate of the cost of a medical service. This bill does not affect people with public health insurance, such as Medicare, Medicaid, Veterans Affairs Health Care, Indian Health Services, and TRICARE, who already had protection against surprise medical bills.
It is important to note:
This law is not retroactive. It only covers medical expenses as of January 1, 2022.
This bill does not cover ground ambulance rides, addiction treatment, or non-emergency mental health counseling. Air ambulances are included.
Looking to the future
Patients will no longer receive balance bills, but who will? The new law sets up a system to answer this question. An arbitration process, like the one used in professional baseball, will help insurance companies and medical providers decide who will pay for unbilled charges.
Yet, medical providers are unhappy with this part of the bill. They believe the process favors insurance companies. The American Medical Association, the American Hospital Association, and others are suing the federal government. The results of the legal action are unlikely to affect most Americans directly but could affect healthcare costs in the future. According to Chartock, “The long-run implications of this policy on overall healthcare costs are not clear and will continue to be worked out over the coming months and potentially years.”
If you think you are being billed unfairly, call the provider who sent the bill. Also call your insurance company. The government’s No Surprises Help Desk is available for questions or complaints. Call 1-800-985-3059 from 8 a.m., to 8 p.m., EST, 7 days a week.