New Federal “No Surprises Act” Effectively Ends Medical Balance Billing

If you have ever been to the hospital, you know what it is like to get the bill after your visit. Whether you went for a sprained ankle or a life-saving surgery, the hospital charged you for your visit. You might be interested to know that a new federal law aims to keep out-of-pockets costs lower for those who need emergency services from out-of-network providers. Known as the No Surprises Act, this new federal law protects patients from devastating “surprise” bills when they go to the hospital or see a doctor who is out-of-network, and essentially eliminates the practice of balance billing. With changes going into effect this year, it is important to know what exactly has changed and what that means for you.

What is balance billing?

If you have health insurance, you probably already know there are in-network providers and out-of-network providers. When you seek care from an in-network provider, your insurance company likely pays most (if not all) of the bill, depending on the treatment you undergo. However, there may be times when you must seek care from an out-of-network provider, such as in an emergency situation like a car accident or ruptured appendix. When your injuries are life-threatening, your last concern is whether or not your surgeon takes your insurance.

As such, many patients found themselves facing significant – and unexpected – medical bills. As the Centers for Medicare & Medicaid Services (CMS) explains, “In many cases, the out-of-network provider could bill consumers for the difference between the charges the provider billed, and the amount paid by the consumer’s health plan. This is known as balance billing. An unexpected balance bill is called a surprise bill.”

What is the No Surprises Act?

With these surprise bills, it was only a matter of time until someone did something about it. The purpose of the No Surprises Act is simple, as it:

[P]rotects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.

The act seeks to cut costs for patients in a major way. One of the most significant advantages of the bill is the cost reduction for air ambulances. Because rural hospitals have been closing at an extraordinary rate for years, many people with catastrophic injuries must be airlifted to hospitals to get life-saving treatments. The average cost of an air ambulance is $30,000 – and most insurance companies don’t cover them. Including out-of-network air ambulances in the bill may not only lead to more lives saved, but also to fewer medical bankruptcies.

Interestingly, this act not only helps those who are insured, but also those who are uninsured as well. The act makes it so that the uninsured patient can get a good-faith quote from their doctor before a visit, and if the resulting bill is vastly different than the quote, the patient can dispute the charges. In previous attempts to curb surprise bills, disagreements over how insurers and medical providers should settle out-of-network costs kept those bills from passing.

What about Georgia’s laws regarding balance billing?

The No Surprise Act is intended to pick up where state laws leave off. In 2020, Georgia passed House Bill 888, which provided some protections to covered patients. For example, the bill would ensure that patients in emergency situations would not face surprise bills when their treating doctors were out-of-network, and that the insurance companies would bill the hospitals or facilities, not the patients. All of these rules still apply, but now patients are also covered by the federal No Surprises Act, which offers further protections.

What to do if you get a surprise medical bill?

The No Surprises Act does not guarantee you will not get an unexpected medical bill. It ensures that you have legal protections to avoid these bills, and a path to dispute them. If you go to the hospital for an emergency, make sure to check all your medical and doctor’s bills. Per CNBC, “Even if an out-of-network provider offered you a service at an emergency facility, they can’t bill you at a rate above what an in-network provider would, including any cost sharing your plan requires.”

If you suspect you have received an improper medical bill, make sure to call your insurance company first. If they have not received the bill or cannot validate that bill, contact your medical provider to see where the mix-up occurred. If you still have concerns about the bill, you can submit an official complaint online at the government website. If you file a complaint, do not pay anything on your bill as it could be used to show that you accept responsibility for the costs.

The No Surprises Act should save Americans thousands of dollars every year. Additionally, stressful surprise bills for having to go to an out-of-network hospital or doctor, even for an emergency visit, should be greatly reduced or even eliminated.

Harris Lowry Manton LLP is a premier medical malpractice law firm serving clients throughout Georgia. To schedule a free consultation with an experienced member of our team, please call our Atlanta office at 404-998-8847 or our Savannah office at 912-417-3774, or fill out our contact form.