There are now new protections that prevent surprise medical bills. It's called The No Surprise Act, and it means exactly that when it comes to your medical bills.
Troubleshooter Diane Wilson often hears from frustrated viewers who make a trip to the ER or have a procedure at the hospital and think they're covered by their insurance since it's an in-network provider, only to learn that a part of their services was from an out of network provider--leaving them stuck with a big unexpected bill.
In the past, in addition to any out-of-network cost-sharing you might owe, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid unless banned by state law. This is called "balance billing." An unexpected balance bill from an out-of-network provider is also called a surprise medical bill.
The No Surprise Act took effect in 2022, and it's aimed at stopping surprise billing.
Under the new law, according to the Centers for Medicare and Medicaid Services, if you get health coverage through your employer, the Health Insurance Marketplace, or an individual health insurance plan you purchase directly from an insurance company, these new rules will:
- Ban surprise bills for emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
- Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for all emergency and some non-emergency services. You can't be charged more than in-network cost-sharing for these services.
- Ban out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers who work at an in-network facility.
- Require that health care providers and facilities give you an easy-to-understand notice explaining that getting care out-of-network could be more expensive and options to avoid balance bills. You're not required to sign this notice or get care out-of-network.
If you don't have health insurance, these new rules make sure you can get a "good faith estimate" of how much your care will cost, before you get care.
As a consumer, you can now file a complaint if you received a medical bill that's higher than an estimate. You can do that here.
It's always wise before any procedure to ask if it's covered under insurance and what your expected costs will be, as it's good to get as much as you can in writing to protect yourself from surprise medical bills.