2024 Pay or Play Affordability Percentage

No Surprises Act Effective January 1, 2022

The Consolidated Appropriations Act, 2021 was signed into law in December of 2020. It included the No Surprises Act, which bans surprise medical bills.

What is “Surprise Medical Bills”?

When patients receive care unexpectedly from out-of-network health care providers, they can get hit with surprise medical bills. This can happen when a patient goes for treatment, like an emergency procedure, at an in-network hospital but receives treatment from an out-of-network doctor. Although the patient did not choose the provider, they are responsible for the bill, which can be hundreds to thousands of dollars.

No Surprises Act

The No Surprises Act will prevent providers from billing patients who have health coverage for unpaid balances. Instead, the group health plan or health insurance issuer will work with providers to determine the amount to be paid by the plan or issuer. Beginning January 1, 2022, patients will no longer have to worry about surprise medical bills from doctors, hospitals, or air ambulances. Patients will only pay what they would have if their care had been performed in-network. The only exception is ground ambulance transport.

Unsettled Bills

If insurers and providers cannot agree on an appropriate amount, then the unsettled bill enters arbitration. Each side submits their best offer, and the arbitrator chooses one, leaving the loser to also pay the arbitration cost. Health experts predict the new law will push more providers to join insurer networks.

To read more about the No Surprises Act, click here.