As provided in the federal No Surprises Act (the “Act”), effective January 1, 2022, patients who have certain unanticipated medical expenses will be protected from egregious medical bills.
The most common covered scenarios are (a) emergency care provided at an out-of-network facility, (b) emergency care provided at an in-network facility by out-of-network and (c) out-of-network non-emergency care provided at in-network facilities without informed consent.
The Act covers air ambulance, but not ground ambulance, trips.
Patients would only be required to pay the in-network amount. And this amount would count toward the patient’s health care insurance deductible.
Out-of-network providers will not be permitted to bill patients more than the cost-sharing amount unless the provider gives the patient notice of the provider’s out-of-network status, delivers to the patient an estimate of charges within certain timeframes, and obtains the patient’s written consent prior to the delivery of care. (Written consent is not valid if the care is for urgent services, or the provider is an ancillary provider that a patient does not select, such as emergency medical, or a hospital radiologist or anesthesiologist.
Providers may be entitled to additional payments from the health insurance company under certain circumstances. If a provider and an insurance company cannot agree on the amount of an additional payment, the matter goes to arbitration.
A violater of the Act is subject to penalties of up to $10,000 per violation.
An individual state’s laws may preempt the provisions of the Act.