What is the No Surprise Act?
The “No Surprises Act” is one piece of H.R. 133, Omnibus Appropriations, and Emergency Coronavirus Relief Act. Often referred to as “The Act,” for short, lawmakers designed this law with the patients’ protection in mind, and it outlaws:
- Emergency service providers were sending surprise bills to patients.
- Non-emergency service providers were sending surprise bills to patients.
In addition to the patient’s protection from surprise medical bills, otherwise known as balance billing, the No Surprise Bill law lays out how arbitrators will handle disputes between service providers and health care plan providers moving forward.
Beginning on January 1, 2022, excluding ground ambulance transport, providers may no longer charge patients more than the cost-sharing due for in-network services. The Act applies to any situation in which out-of-network billing might surprise a patient.
- A surprise medical bill has two components.
- One of which is the difference between the patient’s health plan designated cost-sharing for services rendered by out-of-network providers and their designated cost-sharing for services rendered by in-network providers. For example, you might pay 10% for in-network services and 20% for out-of-network services.
- Component two is the difference between the provider’s full charge and the allowed charges negotiated by insurance companies and providers. While much of the surprise medical bills are emergency services, there are also surprise medical bills related to non-emergency services.