Surprise billing or balance-billing can happen when a patient gets billed for amounts their insurer will not cover for an out-of-network provider. Many consumers have received unexpected bills when they are taken to out-of-network hospitals in emergent situations or are unaware that they were treated by an out-of-network provider at an in-network facility. This sometimes happens with anesthesiologists or other providers that were working at the in-network hospital but are actually out-of-network providers.

The Consolidated Appropriations Act passed in December will eliminate many of those concerns, starting in 2022. According to bipartisan Committee leaders from the House and Senate, this deal will “protect patients from surprise medical bills and promote fairness in payment disputes between insurers and providers.”  The new law does not go into effect until 2022, but it will prevent members from receiving balance bills from emergency care visits, air ambulance rides, or when they unknowingly receive care at an in-network facility from an out-of-network provider. Patients can only be held responsible for amounts based on in-network benefits as determined by their medical plan. Medical providers will not be able to collect from patients the difference between these in-network benefits and higher amounts they wish to charge. Instead they will have to negotiate acceptable payment with the insurance carriers. Unfortunately the bill does not have any patient protections for ground ambulance transportation.

The new law will extend to most insurance plans including self-insured employer plans. Many states have also passed protections from balance billing, but the state laws may have limitations that are addressed by this federal law.

If you have questions or would like to hear more about protections from balance billing, please reach out to your Fall River Client Manager.