New Protections from Surprise Medical Bills Go into Effect in 2022

January 05, 2022

New Protections from Surprise Medical Bills Go into Effect in 2022

Federal agencies have published regulations to implement the No Surprises Act (NSA), establishing new federal protections that will take effect in 2022 against surprise medical bills.

Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose. The federal government estimates the NSA will apply to about 10 million out-of-network surprise medical bills a year.

Surprise billings occur in about 1 in 5 emergency room visits. In-network hospitalizations for non-emergency care include surprise bills from out-of-network providers such as anesthesiologists not chosen by the patient. Surprise medical bills pose financial burdens on consumers when health plans deny claims or apply higher cost-sharing. Consumers also face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates from the insurer. The NSA will protect consumers from surprise medical bills by:

• requiring private health plans to cover these out-of-network claims and apply in-network cost-sharing, and
• prohibiting doctors, hospitals, and other covered providers from billing patients more than the in-network cost-sharing amount for surprise medical bills.

“The No Surprises Act is a welcome change to start 2022,” said Fiesta. “It is bad enough to have a health setback without coming home to an astronomical bill when you thought you would be covered.”