What the New National Ban on Surprise Medical Bills Means for You
It's safe to say that just about every American has, at one point in their life, been shocked by a completely unexpected medical bill.
When I was pregnant with my son, I went above and beyond to make sure that every specialist and every doctor that I needed to see during my pregnancy was part of my insurance's in-network approved providers.
My husband and I paid extra for both me and our un-born baby covered by my medical insurance as well as his because we knew in the long run, our out-of-pocket cost would be substantially less.
We were in for a surprise. It wasn't an earth shattering surprise, but for cash strapped new parents, it was a surprise all the same.
Our son's birth didn't end up going as we had hoped it would and I found myself undergoing an emergency C-section in which an anesthesiologist was called in. Being in an emergency situation, neither my husband or I had time to verify with our insurance company that the anesthesiologist caring for me was in-network and frankly, doing so was the furthest thing from our minds in such a critical time.
It was only a few weeks after the birth of our son that we discovered the anesthesiologist present when my son was born was actually not part of our insurance's list of approved in-network providers. We were completely blindsided when we received a bill for over $1,500 and there was nothing that we could do about it.
Patients being blindsides by surprise medical bills is coming to an end in America thanks to the No Surprises Act which was enacted as part of the Consolidated Appropriations Act. Effective on January 1, 2022, the No Surprises Act now offers federal protection for patients who have insurance against any surprise medical bills.
According to research conducted by Yale University, about one in five visits to an Emergency Room ends with the patient receiving out-of-network care and a heap of hospital bills to go with it. What's more is that between 9 percent and 16 percent of all in-network hospitalizations come with surprise bills from out-of-network providers that the patient didn't have a say about.
These surprise medical bills have unfortunately, led to unavoidable medical debt for millions of Americans. Until now.
New in 2022 is the which protects individuals with private health insurance from being blindsided by surprise hospital bills for providers they had no choice to choose- such as the anesthesiologist who was present when my son was born.
The No Surprises Act now requires private health plans to cover out-of-network claims as well as apply in-network cost sharing. This applies to all private health insurance plans, even those grandfathered in along with both job based plans and non-group plans.
When an insured individual receives care from an out-of-network provider, their insurance company generally won't cover the entire cost and in reality, the individual often finds themselves with a bill substantially higher than had the been treated by an in-network provider. When an out-of-network provider bills an individual the difference between the amount billed and the amount paid by the insurance provider, this is called "balance billing.”
The No Surprises Act will also block doctors, hospitals, and other providers from sending a patient a bill for more than the in-network amount for surprise medical bills.
Not included in the protect of the No Surprises Act are any individuals who receive health coverage through programs which include Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. The reason is that all of these programs already prohibit balance billing.