What is the No Surprises Act?
As of January 1st, 2022, federal law has banned “surprise medical bills.” The No Surprises Act bans unexpected charges known as out-of-network medical bills. . Patients now have the autonomy to seek medical help without worrying about surprise medical bills that could put them in financial turmoil. The protections implemented ensure patients receive necessary information, including anticipated costs and details about their treatment and rights. The Biden Administration has taken a step forward to ensure better and more transparent healthcare.
Why Does It Matter?
Prior to No Surprise Act being implemented, patients would seek medical treatment without knowing it was out-of-network or seek medical treatment from an in-network facility but an out-of-network provider, and then were burdened with a potentially astronomical medical bill. The No Surprise Act is a huge step towards protecting patients by requiring full transparency as to the cost of the service. Patients should not go bankrupt when seeking necessary care.
Can These Rights be Waived?
Patients should still be wary that some doctors may request them to sign a waiver which waives their rights to the protections under this law; however, the notice and consent waiver is not permitted for:
- Emergency Services
- Items and services provided by assistant surgeons, hospitalists, intensivists
- Diagnostic services
- Services provided by an out-of-network provider if there is not an in-network provider who can provide said services.
How Am I Protected from Surprise Medical Bills?
The No Surprises Act bans surprise bills for emergency care, cost sharing for out-of-networks, and other out-of-network rates. When a out-of-network provider bills a patient the difference between the charges the provider billed and the amount paid by the patient’s insurance, this is known and balance billing. An unexpected balance bill is also a surprise bill. Additionally, doctors such as anesthesiologists, radiologists, and assistant surgeons are some of the providers that were considered “out-of-network” by an insurance provider. Patients are protected from out-of-network medical bills from doctors who do not fall within their insurance network. These protections apply to:
- Emergency care
- Elective care
- Air ambulance services
Independent Dispute Resolution (IDR)
If a patient receives what they deem as a surprise medical bill, they have the opportunity to appeal it. Doctors and insurance companies have 30 days to agree upon a rate that is suitable for both parties. If the parties do not agree, federal arbitration can be requested. This process is called Independent Dispute Resolution. Independent dispute resolution allows the doctor and the insurance company to reach out to an arbiter. The arbiter then picks a rate that is closest to the median in-network rate of doctors that fall within the patient’s insurance network.
What is the Good Faith Estimate?
The Good Faith Estimate is a notice of expected charges for services provided. The Good Faith Estimate protects:
- Patients who do not have health insurance
- Patients who have health insurance but decline to use their insurance for treatment costs
- Patients who shop for care
The act allows them to receive an estimate of the cost of care provided. The cost of all procedures, tests, and services provided must be disclosed to the patient. This federal law stipulates that only these three groups of patients must be provided with the cost of services in writing prior to their treatment. For services provided after the bill passed, a patient can dispute a medical bill if the final chargers are at least $400 higher than the provided good faith estimate. The dispute must be filed within 120 days of the date on the bill. Therefore, it is important to know your rights and diligently dispute any surprise medical bills.
Other Helpful Links:
- NPR: Ban on Surprise Medical Bills
- KFF.org: The No Surprises Act Begins January 2022: This is What You Can Expect
- HHS.gov: HHS Kicks Off New Year with New Protections from Surprise Medical Bills
- Axios: Many surprise medical bills are now illegal