New Medical Law Bans Surprise Medical Bills Come Into Effect 2022

Providing stimulus relief for the Covid-19 pandemic, US Congress together with the President signed the No Surprises Act into law and the providing of federal consumer protections against surprise medical bills. This is according to a recent article published in The New York Times. 

Taking effect for health plan years beginning on or after January 1, 2022, the new law will see consumers with private health plans from employers or non-group health insurance policies from outside the marketplace now protected from unfair, high, and unexpected out-of-network medical bills.  

Emergency Medical Bills And Unfair Billing Rise Over The Years But Escalate in 2021 

Due to a lack of knowledge pertaining to insurance regulations and healthcare, 20 percent of U.S. patients treated by out-of-insurance-network emergency care and professionals experience surprise billing following treatment.  

Contributing to the problem experienced by individuals who were treated by medical groups, emergency room doctors, radiologists, or laboratories and then left with surprise billing is the pandemic as well as the lack of knowledge and unawareness of healthcare minutia. 

Then worsening the problem is skyrocketing emergency medical care expenses as well as growing bills from high deductible plans. However, this new law will eliminate current risks and financial struggles faced by the population. 

Now in 2022, a new arbitration system set up for providers and health insurers will ensure fair payment across the board. With banning and illegalization of surprise bills, effective coverage over a large proportion of most routine care and almost all emergency medical services will be embraced by patients. This is according to a recent article published in The New York Times. 

US citizens are encouraged to review the full details of the act and should take note of the following key provisions, provided by KFF, to ensure full protection against surprise medical bills and costs: 

• Health plans must cover surprise bills at in-network rates for emergency services when prior authorization is completed.  
• Balance billing by out-of-network providers for emergency services is prohibited.
• Out-of-network providers are prohibited from sending patients bills for excess charges for amounts higher than in-network cost-sharing amounts for said services.  
• In respect to private health plans, specific oversight and enforcement activities are required. 

Those Protected Will Benefit From This Consumer Victory

For those with law-applicable health insurance and plans can benefit from this pro-patient, momentous victory that protects them against the growing egregious and pervasive billing practice within the US. 

Now, those applicable, will not be responsible for payment of the following: 

• Payments over and above common cost-sharing for in-network services 
• Initial charges and medical bills from doctors not requested by the patient and doctors who do not accept an individual’s health insurance. 
• Additional bills for routine hospital procedures and scheduled medical services performed by an out-of-network doctor chosen by the patient and in the case that notification was provided to the doctor in advance, a “good faith estimate” of the charges was provided, and a form was signed that only mentions choices of doctors who accept the patient’s insurance.
• Routine hospital procedures and scheduled medical services, like knee operations and C-sections, performed by a doctor, anesthesiologists, radiologists, pathologists, and laboratories within the patient’s insurance plan’s network.

Charges That Individuals Will Still Be Liable For 

Individuals with health insurance and plans – that adhere to law provisions – who are treated for a medical emergency at an urgent care center or hospital emergency room will still have to pay for the following: 

• A deductible or co-payment. 
• Surprise bills directly from air ambulances and ground ambulances, and bills from an ambulance company. 
• Additional bills for routine hospital procedures and scheduled service performed by an out-of-network doctor chosen and requested by the patient in the case where notification of the doctor is performed, a “good faith estimate” is calculated and a form agreeing to conditions of care and the possible payment of extra fees is signed by the patient.

Advice For Those Seeking Medical Care In The US During 2022 

As the government continues to take steps to make the costs of medical care more transparent and more affordable, US citizens must do everything to get to know the country’s healthcare system and medical legislation. With this, full awareness of changing medical laws and new consumer protection acts will offer further consumer protection. 

Understanding how insurance benefit works, which doctor is included in what health insurer’s network, and what is expected from health plans will further put those seeking medical care on good financial footing.