No More “Surprises” for Patients

A surprise medical bill, also known as a balance bill, occurs when a provider bills a patient for the difference between the amount the provider charges and what the patient’s insurance pays. This usually occurs when a patient has PPO coverage and unknowingly goes to an out-of-network provider — for instance, when they need to be transported in an ambulance or receive treatment at an out-of-network hospital. Some patients might even get surprise bills even though they used an in-network facility because the care they received at the in-network facility was from an out-of-network doctor.

The “No Surprises Act” takes effect beginning Jan. 1, 2022. Patients only pay what they would have paid if their care had been performed in network. Insurers and the out-of-network medical providers must work out a compromise within 30 days. If that’s not possible, unsettled bills can enter arbitration.

There’s disagreement on the possible effects of the act. The Congressional Budget Office estimates that the act’s provisions will reduce premium growth by 0.5% to 1%, while the Centers for Medicare & Medicaid Services believes premiums will slightly increase.

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