One of the many constants of American medical care in the past few years has been the unexpected: Surprise medical bills. Around one in every six times someone checks into the hospital, or is taken to an emergency room, the treatment is followed by a surprise medical bill, a 2019 study found. But as of January 1, 2022, federal law now bans many types of surprise medical bills.
Patients with insurance will no longer receive so-called “surprise bills” following emergency medical care from an out-of-network doctor or facility. Patients will still be responsible for any deductibles and copays they normally would have to pay under their plan, but they may only be billed at their plan’s in-network rate.
Patients will also be protected if an out-of-network clinician is involved in a planned procedure at an in-network hospital, like if a surgeon is called in to assist during an operation, or a patient’s anesthesiologist is out-of-network.
The law also requires out-of-network providers to give patients notice of their charges 72 hours in advance of a planned procedere. Patients will have to agree to receive out-of-network care to be billed.
If a patient receives unexpected out-of-network care, health service providers and insurers will now be responsible for submitting their billing disputes to an independant arbiter.
Air ambulance services will also be banned from sending patients surprise bills for any more than the in-network cost.
However, the legislation does not affect ground ambulances, instead calling for more study of their billing. This means that patients are still responsible for any ground ambulance charges, even if they are higher than their in-network rates.
The new changes resulted from Trump-era bipartisan legislation, which lawmakers continued to work on after President Biden took office. In May 2019, the Trump administration urged legislators to prohibit charging more than in-network amounts in emergencies, and to mandate informing patients about out-of-network providers during non-emergency care.
In December 2020, Congress passed a $900 billion COVID-19 relief bill that included the main provisions of the law coming into effect January 1, 2022..
“This has been a profoundly distressing pocketbook issue for families for years,” said Karen Pollitz, a health insurance expert with the nonpartisan Kaiser Family Foundation, told the Associated Press. “Some of these bills are onerous, and they all strike people as completely unfair.”
“Generally speaking, keeping the consumer out of it and forcing the providers to be the ones to settle is a positive,” said Eagan Kemp, a policy expert with Public Citizen, a liberal advocacy group, also told AP.
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