Starting from Jan. 1, 2022, Americans will get protection from receiving surprise medical bills under the No Surprise Act.
At the beginning of the new year, a new law came into effect. This bill will put an end to surprise medical bills for insured people who receive emergency medical care and other health services in the US.
Congress passed the No Surprise Act last December with the support of bipartisan. They established new federal protections against surprise medical bills.
Before any further discussions, let’s understand the meaning of surprise medical bills and more about it.
Meaning of surprise medical bills
The meaning of the No Surprise Act states the surprise medical in a specific context. It is essential because many situations can be surprising but don’t fall into the official bucket of surprise medical bills. These situations may include not being aware of your health insurance as it has a high deductible or a specific procedure that may cost more.
Although these bills are quite surprising, they do not cover under the No Surprises Act.
How No Surprises Act protects patients from surprise medical bills?
The No Surprises Act ensures privately insured patients will pay no more than the in-network rate when treated at out-of-network facilities or by out-of-network healthcare professionals without their consent. From Jan. 1, patients will get protection from surprise medical bills in emergency cases, nonelective emergency cases, and air ambulances.
Earlier, the law did not cover ground ambulances, but it has created an advisory committee to develop recommendations related to enforcement mechanisms, surprise-billing protections, and disclosure of charges.
However, people still get an option to get treatment from out-of-network healthcare facilities and professionals for elective procedures. However, the new law stipulates that they must be told ahead of consent and time.
The No Surprises Act also establishes a procedure for how providers and insurers balance bills. The two will negotiate the prices, and if a solution is hard to reach, an independent arbiter will be brought in to determine a fair reimbursement.
Will the new law affect premiums?
According to the rule, when a dispute goes to arbitration, the arbiter must begin with the presumption that the qualifying payment amount is appropriate to pay for out-of-network care.
Other factors may be considered, as the healthcare professional experience, the complexity of care, hospital type, but are not weighted equally.
Many healthcare professional organizations, including the American Medical Association and American Hospital Association, have filed lawsuits, stating the rule gives insurers an unfair advantage.
Few people have also raised concerns about the No Surprise Act, leading to an increase in healthcare premiums.
What to do if you get a surprise medical bill after Jan. 1, 2022?
While the No Surprises Act is meant to stop the issuance of surprise medical bills to patients, if you do receive one after Jan. 1, there are a few steps you’d need to take to rectify it.
There are expectations of situations like these, and it may take some time for the facilities, providers, and insurers to understand the new rules and get them right. The first step must be to contact your health insurance company.
When you receive the explanation of benefits, it will tell you the amount you are liable to pay and the amount policy is paying. You can then see and compare that with the bill you get from the medical facility, you are getting billed for more than you are liable to be.
Finally, under the new law, a complaint line and website operated by the Department of Health and Human Services will be set up for people who believe they are wrongly issued a surprise medical bill.
However, you must remember that it doesn’t put any effect on best prescription discount card. You can still use them at the pharmacies and get good discounts on prescriptions.